USTAKY January 2022 Ask the Doc Article: Shoulder Labrum
Question:
What is the shoulder labrum? What is a SLAP tear?
Answer:
The labrum is a thin fibrocartilage layer in the shoulder that creates a bumper around the glenoid (the shoulder socket) helping to create a stable ball-and-socket joint. It can become injured when someone dislocates the shoulder or from repetitive overhead activities. A SLAP (Superior Labrum Anterior and Posterior) tear is a common way to describe a labral tear from repetitive overhead activities. Since one of the biceps tendons attaches to the superior labrum (top portion), shoulder motion – particularly overhead with external rotation (twisting the forearm away from the body) – puts strain on the bicep’s tendon and subsequently the labrum. Additionally, shoulder tightness with internal rotation (twisting the shoulder down and towards the body) will push the ball of the shoulder backwards, injuring the labrum.
Shoulder labrum tears are common and do not necessarily mean there is pain or dysfunction in the shoulder. Often, athletes who perform repetitive overhead tasks will have a SLAP tear that has developed to allow them the extreme motions and accelerations to perform at a high level. The clinically significant labrum injuries – those creating pain and dysfunction – usually are a result of tears that dramatically disrupt the bumper role of the labrum. These labral tears usually create pain at the ball-and-socket joint with acceleration of the arm or extremes of motion. Some will also describe the shoulder as feeling unstable. This a common source of shoulder pain in tennis players ages 15 to 40 years old. Similar symptoms in older players are more commonly associated with rotator cuff problems.
Many labral tears can be successfully treated with physical therapy. By stabilizing the shoulder blade and optimizing its motion during overhead tasks, the glenoid (shoulder socket) is in a better position to keep the ball centered decreasing the strain on the labrum. Additionally, the therapist can work on shoulder rotation flexibility, dynamic stability through rotator cuff strengthening and biceps stretches. If symptoms persist, you should seek evaluation by a sports or shoulder surgeon.
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