On Balance Magazine - Issue 20

What is a SLAP tear?

A shoulder is a ball and socket joint similar to the hip; however, the socket of the shoulder joint is very shallow and intrinsically unstable, making it susceptible to injury.

A SLAP tear is an injury to a piece of shoulder cartilage called the labrum. This cartilage surrounds the shoulder socket helping to keep it stable during movement.

The arm muscle (biceps) is attached to the shoulder by a biceps tendon. This tendon connects the biceps to the labrum at the top of the shoulder joint.

A SLAP tear happens when the labrum is damaged where the biceps tendon is attached. SLAP stands for Superior Labrum and Anterior to Posterior.

A SLAP tear may result from:

• A fall onto an outstretched hand.
• Repetitive overhead actions e.g. painter working overhead.
• Lifting a heavy object e.g. removalist.

What are the symptoms?

Other parts of the labrum tend to heal more easily due to an adequate blood supply delivering healing capacity to the area of the tear. In the area of SLAP tears this is not the case and chronic shoulder pain can result.

Symptoms can present as a complaint of deep pain within the shoulder either at the back or front of the shoulder joint.

How is a SLAP tear diagnosed?

It can be very difficult to diagnose a SLAP tear. The specialist usually performs a shoulder examination including several tests to detect whether a SLAP tear has occurred.

The specialist must also carefully question the patient to identify symptoms consistent with a SLAP tear. As this type of injury is not often detectable in normal MRI scans, a contrast MRI is performed by injecting a fluid called gadolinium, known for its paramagnetic properties, into the shoulder to highlight the tear.

Sometimes the diagnosis of a SLAP tear is only made at the time of surgery.