That nagging ache in your shoulder, the clicking or popping sensation, the feeling of weakness when you reach overhead – sound familiar? While shoulder pain can stem from various issues, one common culprit, especially for athletes and those who perform repetitive overhead movements, is a SLAP tear.

But what exactly is a SLAP tear? Don’t worry, we’re here to break it down.

Decoding the SLAP: Not a High-Five Gone Wrong!

SLAP stands for Superior Labrum Anterior to Posterior. The labrum is a ring of cartilage that surrounds the glenoid, the socket of your shoulder joint. Think of it as a bumper that helps stabilize the ball (the head of your humerus) within the socket. The “superior” part refers to the top portion of this labrum, and “anterior to posterior” indicates that the tear occurs from the front to the back of this superior region.

 

Essentially, a SLAP tear involves damage to this crucial cartilage ring where the biceps tendon (the strong tendon in the front of your upper arm) attaches. Our bicep is responsible for several actions and tasks that we do in everyday life, including lifting up a gallon of milk, picking up our kids or animals, and doing curls in the gym.

 

 

Why Does This Happen? The Research Rundown

Research has identified several factors that can lead to a SLAP tear:

• Repetitive Overhead Activities: This is a major contributor, particularly in sports like baseball (especially pitching), tennis (serving), volleyball (spiking), and weightlifting. The repetitive stress and forceful movements can put significant strain on the labrum. 

 

READ: SHOULDER LABRUM INJURIES AND REHAB

 

• Acute Trauma: A sudden injury, such as falling onto an outstretched arm, a direct blow to the shoulder, or a sudden forceful pull on the arm, can also cause a SLAP tear.
• Heavy Lifting: Improper lifting techniques or lifting excessively heavy weights can put undue stress on the shoulder joint and the labrum.
• Glenohumeral Instability: If the shoulder joint is already somewhat unstable, the labrum may be more susceptible to tearing.
• Age-Related Degeneration: Over time, the labrum can naturally wear down, making it more prone to tears, even with less significant trauma (4). This study was among the first to link SLAP lesions to throwing athletes and suggested a degenerative component.

 

READ: IS EXERCISE THE BEST OPTION FOR OSTEOARTHRITIS?

 

Recognizing the Signs: What to Look For

The symptoms of a SLAP tear can vary, but some common indicators include:

• Pain in the shoulder, often described as deep inside the joint.
• A catching, clicking, or popping sensation in the shoulder.
• A feeling of instability or looseness in the shoulder.
• Weakness in the shoulder and arm.
• Pain when performing overhead activities or reaching across the body.
• Difficulty sleeping on the affected side.

It’s important to note that these symptoms can overlap with other shoulder conditions, making accurate diagnosis crucial. Be sure to chat with a trusted healthcare professional if you have further questions or concerns. 

 

GET STARTED WITH OUR SHOULDER REHAB PROGRAM

Dealing with shoulder pain related to a SLAP tear? Get started with our Shoulder Rehab program through the Prehab App! This 8-week program will progress you through appropriate exercises to modify pain, improve range of motion and set you up for the fundamentals to build strength! Get started today! 

 

Diagnosis and Treatment: Getting Back in the Game (or to Everyday Life)

Diagnosing a SLAP tear typically involves a thorough physical examination by a doctor, including specific tests designed to stress the labrum. Imaging studies, such as an MRI (Magnetic Resonance Imaging) or an MRI arthrogram (where contrast dye is injected into the joint), are often used to confirm the diagnosis and assess the extent of the tear.

 

 

Treatment options depend on the severity of the tear, the individual’s activity level, and their overall health. (1)

• Non-Surgical Treatment: For less severe tears or in individuals with lower activity levels, conservative treatment may be recommended. This can include:
  • Rest: Avoiding activities that aggravate the pain
  • Ice: Managing pain & severity of symptoms
  • Pain medication: Over-the-counter or prescription pain relievers and anti-inflammatory drugs.
  • Physical therapy: A tailored exercise program to strengthen the surrounding muscles, improve stability, and restore range of motion. (2) (More on specific exercises coming up!)
  • Surgical Treatment: If non-surgical treatment fails to provide relief, or for more severe tears, surgery may be necessary. Arthroscopic surgery is the most common approach, where a surgeon inserts small instruments and a camera through tiny incisions to repair the torn labrum. This often involves reattaching the labrum to the bone using sutures and anchors. (3) SLAP tears are typically surgically repaired arthroscopically and can take several weeks to months to heal from.

 

READ: THE TRUTH ABOUT ICING INJURIES

 

Rehabilitative Exercises for a SLAP Tear

We all know that ‘motion is lotion’, and recovering from a SLAP tear is no exception!

Here are some general examples of exercises that are often incorporated, progressing in difficulty as you recover:

Early Phase 

The goal for early phase treatment is pain, excessive inflammation reduction and gentle movement.

Pendulum Exercises: Lean forward slightly, allowing your arm to hang freely. Gently swing your arm in small circles (clockwise and counterclockwise), forward and backward, and side to side. This helps maintain gentle range of motion without stressing the joint.

 

Isometric Exercises (Sub-maximal and pain-free): These involve contracting your muscles without moving your joint. Isometrics are a fantastic way to also help to mitigate pain due to their analgesic nature. Examples include:

• • Shoulder Flexion Isometric: Press your forearm gently into a wall in front of you. Hold for a few seconds and relax.
  • Shoulder Abduction Isometric: Press the outside of your upper arm gently into a wall beside you. Hold for a few seconds and relax.
  • Shoulder External Rotation Isometric: With your elbow bent at 90 degrees and against your side, gently press the back of your hand into a wall. Hold for a few seconds and relax (see the exercise below!)
  • Shoulder Internal Rotation Isometric: With your elbow bent at 90 degrees and against your side, gently press the palm of your hand into a wall. Hold for a few seconds and relax.

 

Intermediate Phase 

The goal for intermediate phase exercises is increasing range of motion and light strengthening.

Active-Assisted Range of Motion: Similar to passive range of motion, but you initiate the movement with your own muscles and use your unaffected arm for assistance as needed.

Active Range of Motion: Performing movements like forward flexion, abduction, adduction, external rotation, and internal rotation using only your own muscles, within a pain-free range.

Resistance Band Exercises (Light Resistance):

• • External Rotation with Band: Hold a resistance band with both hands, elbows bent at 90 degrees and against your sides. Slowly rotate your forearms outward, keeping your elbows tucked in.
  • Internal Rotation with Band: Anchor the resistance band to a stable object. Hold the other end with your affected arm, elbow bent at 90 degrees and against your side. Slowly pull your hand across your body.
  • Rows with Band: Secure the band around a stable object. Pull the band towards your body, squeezing your shoulder blades together.

Scapular Retractions (Squeeze Shoulder Blades): Sit or stand tall and gently squeeze your shoulder blades together as if trying to pinch a pencil between them. Hold for a few seconds and relax. This strengthens the muscles that stabilize your shoulder blade.

Late Phase 

The goal for late phase exercises is progressive strengthening and return to function.

Free Weight Exercises (Light Weights, Gradually Increasing): Exercises like dumbbell rows, bicep curls, triceps extensions, shoulder press (starting with very light weights and focusing on proper form, avoiding overhead movements initially if they cause pain).

Plyometric Exercises (for athletes, as appropriate and guided by a therapist): Exercises like wall push-ups with a clap or medicine ball throws to improve power and speed.

Sport-Specific Exercises (for athletes, under guidance): Gradually returning to sport-specific movements with increasing intensity. For a baseball pitcher, this might involve light throwing drills that progressively increase in distance and velocity.

 

Important Considerations for Exercises:

• Pain is Your Guide: Never push through sharp or increasing pain. Some mild discomfort is expected, but stop if the pain becomes significant.
• Proper Form: Focus on performing each exercise with correct technique to avoid further injury and maximize effectiveness. Your physical therapist will guide you on proper form.
• Gradual Progression: Increase the intensity, duration, and resistance of your exercises gradually as your shoulder heals and strengthens.
• Consistency is Key: Adhere to your prescribed exercise program for optimal recovery.
• Listen to Your Body! Pay attention to any new or worsening symptoms and communicate them to your healthcare team.

 

Closing Thoughts

If you’re experiencing persistent shoulder pain and suspect it might be a SLAP tear, don’t ignore it! Seeking early diagnosis and appropriate treatment can help you get back to your favorite activities and enjoy a pain-free life. Consult with a healthcare professional to get an accurate diagnosis and discuss the best treatment plan for you.

Exercise is your ally! Rehabilitation exercises are a cornerstone of recovery, whether you undergo surgery or opt for non-surgical treatment. A physical therapist will design a specific program tailored to your needs and stage of healing.

 

GET STARTED WITH OUR SHOULDER REHAB PROGRAM

 

References

1. Maffet, M. W., Walch, G., Goutallier, D., Boileau, P., & Kempf, J. F. (1995). Superior labrum anterior and posterior lesions of the shoulder. Journal of Shoulder and Elbow Surgery, 4(1), 22-28.
2. Wilk, K. E., Andrews, J. R., Clancy, W. G., & Fowler, P. J. (1997). Nonoperative rehabilitation of rotator cuff injuries. Sports Medicine, 24(3), 196-219.
3. Brockmeier, S. F., Voos, J. E., Williams, R. J., & Warren, R. F. (2009). Outcomes after arthroscopic repair of type II superior labral anterior-posterior lesions: minimum 2-year follow-up. The American Journal of Sports Medicine, 37(9), 1716-1722.
4. Reilly, P., & Macnab, J. (1990). Superior labrum lesions in throwing athletes. The American Journal of Sports Medicine, 18(1), 51-54.

 

Taryn Beaumont, PT, DPT, CLT, CF-L1, CNC

[P]rehab Writer & Content Creator

Taryn was born and raised in Maine and still resides there with her fiancé and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelor’s in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 2 Trainer, and a NASM Certified Nutrition Coach. Taryn has 12+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Most recently she is employed with a home health PT company and is working toward her Advanced Competency in Home Health. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and CrossFit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing, and reading, and is very excited to be a part of The [P]rehab team to educate and empower others to take control of their health and wellness.

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.