The superior labrum is the upper portion of the cartilage rim that attaches to the edge of your shoulder socket (glenoid. This upper part of the socket and labrum is also the attachment for the long head of biceps tendon. Occasionally a SLAP tear extends into the biceps tendon itself. The term SLAP means - Superior Labrum Anterior and Posterior to biceps. The area marked in red below is the SLAP region. The arthroscopic photograph below shows an unstable SLAP tear.
The superior labrum can be injured either in isolation, or as part of a more widespread shoulder instability picture. SLAP tears in young patients tend to be traumatic or sport-related, but in those over 40, these are normally degenerate, rather than traumatic tears.
Traction injuries, where the arm is forcefully pulled out in front of you, pull through the biceps tendon into the superior labrum and can rip it off the glenoid. Intensive strength training programmes (e.g. Crossfit) can cause superior labral problems through repetitive faulty technique or overwhelming loading. Throwing sports exert repeated twisting forces on the superior labrum. Eventually, this can peel off the superior labrum. Throwers are also prone to posterior capsule tightness. This may cause rubbing against the superior labrum (internal impingement) and SLAP problems. Significant direct blows to the shoulder (landing heavily on the side of the arm) can also cause complex labral tears that may include the superior labrum.
Face on view of shoulder socket (glenoid). Labral cartilage rim with superior labrum and long head of biceps tendon in red
Arthroscopic photograph of an unstable SLAP tear. The long head of biceps tendon is sometimes destabilised by this injury. This patient's injury was repaired.
Most patients have not suffered a complete shoulder dislocation, but patients often say their shoulder ‘isn’t right’. Patients may well recall a precipitating traumatic event, often a sudden pulling event on the arm or a heavy landing onto the shoulder. Patients describe deep-seated pain in their shoulder, sometimes with pain in front and behind. Crossing the arm in front of your body often makes it worse and using the biceps muscle (screwdriver, heavy lifting) can also exacerbate pain. Some patients describe intermittent pins and needle or a ‘dead arm’ sensation
Most patients try the usual combination of rest, activity modification, painkillers and anti-inflammatories to see how things settle.
Physiotherapy helps to restore your range of motion, stretch any tight capsule and to optimise the co-ordination of your muscles. This may offload your biceps and reduce your SLAP symptoms.
Cortisone (steroid) injections may be helpful to relieve pain and enable your physiotherapist to work with you.
If your SLAP tear is a result of an overuse problem, and you continue the sport without correcting your technique or posture, it may get worse. As shoulders rarely dislocate with SLAP tears alone, it is unlikely to cause significant joint damage beyond the superior labral area although your symptoms of pain and clicking may persist. This is often the reason why patients want surgery.
If you are recommended for surgery for a SLAP tear there are two main options:
Arthroscopic SLAP repair
Biceps tenotomy or tenodesis
Your surgeon will explain which options would work best for you based on you and your specific injury pattern. In general, results from clinical studies suggest improved outcomes with biceps tenodesis, rather than a SLAP repair if you are over 35years old.
You will require a period of protection in a sling, with restrictions on movement and function. Whatever surgery you have, you will require a physiotherapy rehabilitation programme. Return to sport will vary with procedure, associated injuries and by individuals, but is unlikely before 5 months after SLAP repair or biceps tenodesis. Contact and overhead sports usually take a bit longer (approx. 7 to 9) months.
Some patients’ shoulders will settle with activity modification and a physiotherapy programme. Of those who need surgery, 85% will be happy with their outcome by 6 months, but a few patients will continue to experience pain during certain activities.
If a SLAP repair fails to help your pain, revision surgery is feasible, but it may be better to perform a tenodesis of the biceps tendon if the tissue quality of the superior labrum is poor.
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
BMI The Princess Margaret Hospital
Osborne Rd, Windsor SL4 3SJ
Spire Thames Valley hospital
Wexham Street, Wexham, Buckinghamshire, SL3 6NH
Wexham Park Hospital, Slough, Berkshire, SL2 4HL
Unit 6, Queen's Square, Ascot Business Park, Lyndhurst Road, Ascot, SL5 9FE