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SLAP tears of the shoulder

SLAP (Superior Labrum Anterior and Posterior) tears are common shoulder injuries for those who partake in overhead sporting activities. The labrum is the cartilage which surrounds the shoulder joint, allowing the joint to be deeper set giving it more stability. When the labrum is torn, the shoulder joint is more susceptible to dislocation and injury of other soft tissue structures.

A common reason for labral tears in those who are involved in overhead sporting activities is due to the stress placed on the biceps tendon, which attaches to the labrum, and repetitive forces can then create a tear. Depending on the degree of the tear, treatment is usually conservative, but surgical options are geared to either reattaching the biceps tendon to the Humerus, or labral repair.

Conservative treatment looks to optimise scapulothoracic function and Gleno-humeral stability through resistance training, joint mobilisation and soft tissue therapy. Should this approach fail, then surgery will then be considered. In high-level athletes, age appears to be a predictor of which surgical procedure offers the best outcome. Historically, a Biceps reattachment offers the best outcome in older athletes, where as a labral repair appears to be optimal in the younger patient. However, there is currently some uncertainty amongst surgeons about which procedure offers the best outcome in athletes returning to sport, due to the lack of knowledge of the role of the Biceps tendon in the throwing action and its role in joint stability. In baseball, there is a return to sport range from 22% to 64% following labral repair, which is of course by no means an encouraging statistic.

LeVasseur, M.R., et al. (2021). SLAP tears and return to sport and work: current concepts. Journal of ISAKOS. 6(4): 204-211.


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