SHOULDER 

Common Shoulder Sports Injuries

What is a SLAP Tear?

A SLAP tear is also referred to as a labral tear, or a tear or lesion to the labrum. This injury tends to develop over time due to repetitive movements. It can also result from acute trauma or age.

There are several types of SLAP tears:

  • Type I SLAP tear involves the fraying of the top rim of the labrum, but it is still attached to the glenoid. This injury is due to the aging process, and commonly found in middle-aged or older patients where symptoms may not be present.1These tears could be treated without surgery.2

  • Type II SLAP tear is the most prevalent type of SLAP tear. In this injury, the labrum and biceps tendon detach from the top of the glenoid. Type II tears can be further categorized as anterior (at the front), posterior (at the back) or a blend of the two. Arthroscopic surgery is normally performed.

  • Type III SLAP tear consists of a bucket-handle tear, where the torn labrum could droop into the shoulder joint.3 The biceps tendon remains intact. Arthroscopic surgery is often needed to remove the bucket-handle segment.

  • Type IV Slap tear is a bucket-handle tear to the top of the labrum, extending into the biceps tendon to varying degrees.3 Involvement of the biceps tendon differentiates this injury from a type III SLAP tear. Treatment options could depend on the extent the biceps tendon is involved.

Labral tears can also occur in the hip, since the labrum surrounds the hip socket, but this is not referred to as a SLAP tear.

Rotator Cuff Injuries: Symptoms

The most common symptoms of rotator cuff injuries are stiffness, weakness, loss of range of motion, and—most notably—shoulder pain.

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  • Shoulder pain. People with rotator cuff injuries complain about pain, especially at night. Pain may also be felt during over-the-head motions or reaching behind the back.

  • Stiffness. The shoulder may feel most stiff when getting out of bed in the morning.

  • Muscle weakness. Lifting the arm overhead or holding the arm away from the body may be difficult. The muscles at the back of the shoulder may appear smaller on the injured side than on the unaffected side.

  • Loss of active range of motion. A person with an injured rotator cuff may not be able to move the arm through a normal range of motion. However, sometimes the arm can still be passively moved, meaning that someone else can lift the affected arm and rotate it through a complete range of motion.

  • Swelling and tenderness. The front of the shoulder is often swollen and tender.

  • Crepitus (shoulder popping). Cracking and popping sensations in the shoulder are also common, and may indicate the shoulder’s ball and socket joint is not tracking properly.

Frequently asked questions

Rotator Cuff

What causes a rotator cuff tear and how would I know if I have one?


A rotator cuff tear may result from an acute injury, such as a fall, or may be caused by normal age-related wear and tear with degeneration of the tendon. Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching. You may feel pain when you try to sleep on the affected side. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back. If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm.




If I have a painful rotator cuff and keep using it, will this cause further damage?


A rotator cuff tear can extend or get larger over time. This can occur with repetitive use or a re-injury. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. This likely represents extension of an existing tear. If you know you have a rotator cuff tear, then worsening pain and decreasing strength may mean the tear is getting larger.




When should I see a doctor for a rotator cuff tear?


If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see your orthopaedic surgeon. He or she can then make a diagnosis and begin treatment. Your doctor may recommend a diagnostic imaging study such as a magnetic resonance imaging (MRI) scan or an ultrasound to confirm the diagnosis. Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as loss of strength and loss of motion from setting in. If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment.




Can a rotator cuff tear be healed or strengthened without surgery?


Many rotator cuff tears can be treated nonsurgically. Anti-inflammatory medication, steroid injections, and physical therapy may all be of benefit in treating symptoms of a cuff tear. The goals of treatment are to relieve pain and restore strength to the involved shoulder. Even though most tears cannot heal on their own, good function can often be achieved without surgery. If, however, you are active and use your arm for overhead work or sports, then surgery is most often recommended because many tears will not heal without surgery.




At what point does a rotator cuff tear require surgery to fix it?


Surgery is recommended if you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching. Many will report ongoing symptoms despite several months of medication and limited use of the arm. Surgery is also indicated in active individuals who use the arm for overhead work or sports. Pitchers, swimmers, and tennis players are common examples.




What is the rotator cuff and what does it do?


The rotator cuff is a group of four muscles that come together as tendons to form a "cuff" over the head of the humerus (upper arm bone). The four muscles—supraspinatus, infraspinatus, subscapularis and teres minor—originate from the scapula (shoulder blade). The rotator cuff tendons attach to the head of the humerus in special spots referred to as the greater and lesser tuberosities. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.





SLAP Tear

What 'SLAP' means


There are many different kinds of shoulder labrum tears. A labrum SLAP tear covers a specific area. The upper, or superior, part of your labrum attaches to your biceps tendon. In a labrum SLAP tear, SLAP stands for superior labrum anterior and posterior. This means your labrum is torn at the top in both the front (anterior) and back (posterior) of where it attaches to the biceps tendon.




What causes SLAP Tears?


There are three ways to tear your labrum: Overuse. Anyone who uses their shoulder to make the same motion over and over can tear their labrum. You might repeat an overhead motion at work or during activity. Think of a weightlifter who jerks a barbell up again and again. Injury. When you slip, it's normal to stretch out your arm to break the fall. The impact on the extended arm can cause a labrum SLAP tear. You can also tear your labrum in a car wreck, by dislocating your shoulder, or while doing something that pulls hard on your arm. Wear and tear. Car tires get worn down when you put a lot of miles on them, and so does your labrum. Day in and day out, your labrum does a lot of work. If you're 40 or older, it’s a common issue. Symptoms In most cases, a labrum SLAP tear doesn't hurt all the time. The pain usually happens when you use your shoulder to do a task, especially an overhead activity. You may also notice: A catching, locking, or grinding feeling An unstable feeling in the shoulder Loss of strength Low range of motion





*All Information provided by The American Academy of Orthopaedic Surgeons

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