Labral Tears and SLAP Lesions of the Shoulder

What is the labrum?
The labrum is a ring of cartilage material located around the shoulder socket (glenoid). The labrum helps contribute to the stability of the shoulder by deepening the socket, and helps to cushion the compression across the socket. The biceps tendon attaches to the labrum at the top of the socket. The ligaments that hold the shoulder in the joint attach in the front and back of the labrum.

Who gets labral tears?
Anyone can get a labral tear. Injury can occur due to repetitive use, and may be more likely to occur in individuals who have instability or looseness of the shoulder joint. A special type of labral tear is called a “SLAP lesion”. This is a tear of the top part of the labrum extending from in front to behind the biceps tendon (SLAP – Superior Labrum from Anterior to Posterior). The most common causes of this type of labral tear are traction (as in the jolt one may experience when water-skiing or when trying to reach up and grab an object overhead when trying to save oneself from falling) or compression (as in falling onto an outstretched arm). Often, patients may get either labral tears or SLAP lesions just from repetitive use and without any specific traumatic incident.

What happens when the labrum is torn?
When the labrum is torn, a flap of labrum can move in and out of the joint, causing shoulder pain, locking, catching, snapping, or grinding. This may be related to certain positions of the arm. If the labral tear makes the attachment of the biceps tendon loose, the shoulder joint may become unstable.

How are labral tears treated?
Initially, rest, ice, and gentle anti-inflammatory medicines are used. However, with repetitive use of the arm, it may be very difficult for a labral tear to heal. In this instance, surgery may be indicated.

What does surgery involve?
This depends on the extent and location of the labral tear. Many labral tears can be treated with a simple arthroscopic shaving (debridement) of the torn flap of cartilage. If the tear extends to the biceps tendon (SLAP lesion), reattachment of the labrum and biceps tendon back to the socket (glenoid) may be required. This is done arthroscopically using miniature screws and sutures. If possible, the labrum may be arthroscopically repaired with suture alone. If there is extensive tearing of the biceps tendon in association with the labrum tear, the biceps tendon may need to be reattached to the bone in the upper arm (biceps tenodesis).

What is the usual course after surgery?
Again, this depends on the extent of the labral tearing and the surgery that was performed. If the labrum only needs to be shaved, then a quick return (within one to three weeks) to almost all activities may be possible. However, if the labral tear of SLAP lesion needs to be repaired, then a more gradual return is necessary. A sling is utilized in the first few weeks after surgery, and immediate use of the hand and elbow is encouraged.

Desk work and light duty can usually be resumed within the first week or two; return to heavy labor usually takes two to four months.

How can I get more information about labral tears or SLAP lesions and treatment?
Please feel free to call Western Orthopaedics, PC at (303) 321-1333 or toll free at 1-888-900-1333 and ask for a referral to one of the shoulder specialist. One of the physicians will be happy to answer your questions and evaluate your shoulder in the clinic.

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