Labral Tear (SLAP)
Damage to the cartilage rim around the shoulder joint.
The labrum is fibrous cartilage around the edge of the socket of the shoulder blade. The upper labrum connects to the long head of the biceps and, like the knee meniscus, is loosely attached to bone, so it is relatively easy to injure.
It often comes with rotator cuff tears, frozen shoulder or recurrent anterior dislocation, making accurate diagnosis difficult. Once seen mainly in baseball players, it is now common in young men under 30 as more people take up sports, often during basketball, baseball and other ball or leisure sports.
Common causes
01
A blow to the shoulder
02
Falling onto an outstretched arm
03
Repeated overhead throwing or swinging
04
Accidents such as falls
Signs to watch for
- Shoulder pain, heaviness and instability
- Severe pain when putting on or taking off clothes over the head
- In severe cases, a feeling that the shoulder will slip out
How we diagnose
MR arthrogram
Some tears are hard to see on standard MRI, so contrast is injected into the joint before scanning.
Ultrasound
Examines the joint while it moves, so problems that appear only in certain positions can be found. Inflamed areas can be treated with guided injections at the same time.
Arthroscopy
Magnifies the inside of the joint on a monitor, so conditions missed by imaging can be diagnosed accurately.
How we treat it
For mild tears we start with conservative treatment such as strengthening and posture correction. Early on, we control acute pain and avoid overusing the joint.
Conservative care
Shoulder stretching, then gradual rotator cuff and shoulder blade strengthening. Early proprioceptive training and passive and active range-of-motion exercises are added as needed.
Manual & exercise therapy
A specialist physical therapist uses hands-on techniques based on anatomy, such as relaxation methods and joint mobilization, to reduce pain and improve function.
Arthroscopy
Through a minimal incision under about 5 mm, an arthroscope with a tiny camera and special instruments is inserted into the joint. It shows areas that are hard to see on X-ray, allowing accurate diagnosis and treatment at the same time.
When surgery is consideredSurgery is considered if there is no improvement or the tear is severe. Most operations can now be done arthroscopically.