Labrum “SLAP” Tears and Biceps Tendonitis
Anatomy
The labrum is a ring of fibrous cartilage surrounding the shoulder joint that helps to deepen the socket and also serves as an attachment site for ligaments and the biceps tendon. A SLAP tear (or lesion) is an injury to the top portion of the labrum.
The biceps tendon attaches at the top of the labrum and into the glenoid bone.
SLAP Tears
A SLAP tear stands for “superior labrum anterior to posterior” which describes a tear at the top portion of the labrum. Because the biceps tendon also attaches into this area, a SLAP lesion commonly involves the biceps tendon.
A SLAP tear can be caused by an acute injury or by repetitive motion over time. Acute causes involve injuries such as: rapid, forceful lifting motions-especially above shoulder level, forceful pulling on the arm, falls, motor vehicle accidents, and shoulder dislocations. Repetitive causes are most commonly found in athletes participating in overhead throwing sports or weightlifters due to repeated shoulder movements. Additionally, jobs requiring manual labor with repetitive shoulder motion can lead to SLAP tears
Tearing and fraying of the labrum are also part of general wear and tear from aging, so a SLAP tear over the age of 30 without an acute injury may just be related to degenerative wear.
Biceps Tendon Injuries
The biceps has two attachments: one inside the shoulder capsule that attaches to the labrum (long head of the biceps), and one outside the shoulder joint that attaches to the corocoid process of the shoulder blade (short head).
Typically, shoulder pain is caused by the long head of the biceps tendon. Pain can be caused from tenosynovitis (inflammation of the biceps tendon), small tears in the biceps tendon or rupture of the biceps tendon.
Bicep tendonitis is usually caused by repetitive motions whereas rupture is caused by more traumatic events such as fall or losing control of a heavy weight.
Symptoms
Some primary symptoms include pain in the shoulder that is often located at the top and/or front of the shoulder. Sometimes the pain will radiate into the upper arm. Pain is generally worse with shoulder movement-especially in certain positions. There may be associated clicking, popping, or catching sensations and noises. It is common to have increased pain with overhead lifting and with overhand throwing. Sometimes, a SLAP tear can cause a false sensation of instability-as if the shoulder is partially moving out of place.
Evaluation
Your healthcare provider will evaluate your range of motion, measure strength, and perform special tests to help diagnose the source of your shoulder symptoms. They will use the results of their exam to determine if you need further testing (e.g. x-ray, MRI, CT scan).
Management
Initial treatment for biceps tendonitis is typically non-surgical. Treatment recommendations will likely include rest, modification of activity, physical therapy, and use of anti-inflammatory pain medication. If your pain is not effectively resolved with these conservative measures, then you may need additional treatment options including a steroid injection or arthroscopic surgery.
SLAP labrum tears are frequently also initially treated with non-surgical management as listed above. SLAP tears are often due to general wear and tear, and many people are able to live with a SLAP tear just by making some activity modifications. When pain is not effectively managed with non-surgical options, then a steroid injection or arthroscopic surgery can also be considered.
In both of the above cases, a steroid injection is often just a temporary means of addressing the pain-it is common for the pain to return after a few months when the effects of the injection wear off. Your healthcare provider will discuss with you whether an injection may be a good option for you or not. Sometimes the best options are determined by factors such as your age, health, level of physical activity, physical job requirements, and amount of time with present symptoms.
Arthroscopic surgery: Surgical intervention for biceps tendonitis and/or SLAP labrum tears is an outpatient procedure. The surgery takes about an hour, and you return home the same day. The most common procedure to treat these diagnoses is called a biceps tenodesis. A biceps tenodesis is a relocation of the long head of the biceps tendon from its attachment site at the glenoid/labrum to a new attachment site on the arm near the armpit. This procedure can treat both biceps tendonitis and SLAP tears.
Sometimes it is necessary to also repair the labrum. This is much less commonly needed, and is based on factors such as type/severity of the labrum tear, instability, age, and involvement in certain high level sports.
