Labrum/SLAP Tear
The labrum is a cup of cartilage that surrounds the shoulder joint. It serves as both an attachment site for the different muscles and tendons as well as deepens the socket to provide enhanced stability. (1) Injuries to the labrum come from either an abrupt insult or repetitive overuse. The most common way a labrum is acutely damaged is from a fall on a forward outstretched arm. (2) In athletic populations, excessive overhead motion is the primary cause of repetitive damage to the labrum. The vast majority of labrum issues occurs along with other shoulder issues, typically rotator cuff and scapular dysfunction.
Typically people feel a deep, vague, non-specific shoulder pain that is provoked by overhead and cross-body activity. There is often weakness and stiffness felt as well. Overhead athletes will often refer to it as “dead arm” and state that it feels weak and loose. Sometimes there are sensations of popping, clicking, grinding or catching.
Treatment and rehabilitation of the labrum focuses on restoring shoulder motion, restoring rotator cuff balance, as well as stability of the hips, core and scapula. (3) The American Academy of Orthopedic Surgeons recommends a 6-12 week course of treatment before a surgical intervention should be considered. Treatment starts with reducing load and avoiding activities of provocation. Flexibility and stretching are started as soon as symptoms allow. As motion improves, strengthening and motor control exercises are implemented for the rotator cuff as well as the scapula. The strengthening program should focus on the balance between the muscles of the front and back of the shoulder girdle. Co-existing dysfunctions must also be treated to prevent recurrence. Manipulation is often used to help restore mobility of restricted joints and manual myofascial release is used to help in healing of soft tissues. In throwing athletes, eccentric control of the shoulder must be focused on to help alleviate the breaking mechanism.
If you have an issue that you would like some guidance with, give us a call at (616) 301-1702.
Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990. 6(4):274-9.
Dessaur WA. (2008). Diagnostic Accuracy of Clinical Testing for Superior Labral Anterior Posterior Lesions: A Systematic Review Journal of Orthopaedic and Sports.
Hester WA, O'Brien MJ, Heard WMR, Savoie FH. Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder. Open Orthop J. 2018 Jul 31;12:331-341. doi: 10.2174/1874325001812010331. eCollection 2018. Review.