Do you also experience severe pain when you raise your shoulder or move your arm back? Do you sometimes hear a 'click' sound from the inside of your shoulder, or do you feel like it's twisting? We often ignore these things as normal. However, sometimes this can be a sign of a serious injury inside the shoulder joint. Today we are talking about a shoulder injury that occurs in such a condition, known in medical science as a SLAP Tear .
Simply put, what is a SLAP Tear?
This name may sound a bit complicated, but let's keep it simple. Our shoulder joint is like a ball and socket joint. The top part of the upper arm bone (the ball) fits into a smaller socket (the cup) in the shoulder bone. Around this socket, there is a strong ring of cartilage that helps to deepen it and keep the ball firmly in place. This is what we call the labrum . In other words, it acts like a gasket and helps to keep the joint stable.
SLAP stands for Superior Labrum , Anterior to Posterior . In Sinhala, this is a tear in the upper part of the labrum, from the front (Anterior) to the back (Posterior) . The upper part of this labrum is where the tendon that connects to our biceps muscle attaches. So when this SLAP tear occurs, the labrum, which is like a cushion in the shoulder, is damaged, and the biceps tendon can also be affected. That's why the shoulder is painful and unstable, and feels like it's "shaking".
What are the main causes of a SLAP tear?
There is not one single reason for this situation, but several factors can contribute to it. Let's look at the main reasons.
| Cause | Description |
|---|---|
| Chronic shoulder injury | This is the most common cause. The labrum can gradually wear down due to prolonged repetitive shoulder activities. For example, this can happen when a cricketer bowls continuously, a swimmer continuously swims, or a weightlifter continuously puts weight on their shoulder. |
| Acute Injury | This tear can also occur due to a sudden accident. This damage can occur due to things like falling and putting your arm outstretched, suddenly trying to lift something heavy (e.g. a gas cylinder), or a car accident. |
| What happens with age (Aging) | Like other parts of our body, the labrum can wear down and weaken over time. These tears are usually seen in people over the age of 40, even if they are not in serious danger. |
Do I have a SLAP tear in my shoulder? What are the symptoms?
If you have one or more of these symptoms, you should be concerned.
- Shoulder pain: This can be a constant ache, or it can be a sudden, sharp, stabbing pain.
- Pain during specific positions: Pain may increase when raising the arm above the head, placing the arm behind the back, or performing movements such as throwing a ball.
- A 'clicking' sound or a grinding sensation: If you hear a clicking sound coming from inside the joint when you move your shoulder, or if you feel like two bones are grinding together, it could be a symptom of this condition.
- A sensation of the shoulder popping: The shoulder joint is not properly supported, and there is an unstable feeling as if it will "pop" at any time.
- Feeling of weakness in the shoulder and arm.
The most important thing is to see a doctor immediately if you have any of these symptoms, rather than ignoring them. If left untreated, the pain can worsen and you may even lose the ability to use your shoulder.
How do you find this, Doctor?
When you go to the doctor, he will first ask you about the pain, how it started, and what you do. Then, he will do a physical examination.
1. Physical Examination: The doctor will rotate and lift your arm in different directions. This will help determine your shoulder's range of motion, muscle strength, and what types of movements cause pain.
2. MRI Scan: The best way to get a good look at the soft tissues inside the shoulder, such as the labrum and tendons, is to have an MRI (Magnetic Resonance Imaging) scan. Sometimes, your doctor may also recommend an MRI Arthrogram, which involves injecting a special dye into the joint to see the tear more clearly.
What are the treatments for this?
Treatment depends on the type of tear, your age, and your activity level. Not all SLAP tears require surgery.
Non-Surgical Treatments
First, the doctor tries to cure this without surgery.
- Rest: Staying away from the activities that are causing shoulder pain for a while.
- Painkillers: Anti-inflammatory drugs prescribed by your doctor to reduce swelling and pain.
- Cortisone shots: A special injection that is injected directly into the joint to quickly reduce pain and swelling.
- Physical Therapy: This is a very important treatment. Under the guidance of a physical therapist, exercises that strengthen the muscles around the shoulder can help stabilize the joint and reduce pain.
Surgical Treatments
If the pain does not subside after 3-4 months of the above treatments, or if the tear is very severe, your doctor may recommend surgery. This surgery is often performed arthroscopically . This means that a camera and delicate instruments are inserted through several small incisions in the shoulder to repair the torn labrum.
- Labral Repair: Reattaching the torn labrum to the bone.
- Biceps Tenodesis: Sometimes, if the biceps tendon is damaged, it is removed and reattached to a safer location in the shoulder.
How long does it take to heal?
This is the problem that many people have. Recovering from a SLAP tear is not an overnight race, but a marathon that takes time.
Patience and dedication are very important. Even without surgery, it can take 3-4 months for the pain to subside and for the patient to return to normal. If surgery is performed, it can take 6 months to a year to fully recover and return to activities such as sports. After surgery, you will need to wear an arm sling for a few weeks. Also, doing the exercises prescribed by the physical therapist exactly is essential for a speedy recovery.
How can we prevent this situation from happening again?
Yes, there is a risk of re-injury, especially if you start playing sports or doing work that puts a lot of strain on your shoulder again. So be aware of these things:
- Warm up well before exercising: Warm up your shoulder muscles well before playing sports.
- Listen to your body: If you feel pain or stiffness in your shoulder, don't ignore it and rest.
- Use proper technique: Use proper form when lifting weights and playing sports. Don't lift weights with sudden jerks.
- See a doctor: If pain persists or a new injury occurs, seek medical advice.
Take-Home Message
- Shoulder pain, especially if accompanied by a 'clicking' sound, may be a symptom of a SLAP tear.
- This can be caused by frequent shoulder use, an accident, or aging.
- Don't ignore shoulder pain, see a doctor immediately and get an accurate diagnosis.
- Surgery is not mandatory for treatment. Physical therapy and rest are very important.
- It takes time to recover, so be patient and follow the instructions given by your doctor and physical therapist.
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