Strength in Numbers #191
Superior Labrum Anterior to Posterior (SLAP) tears are injuries to the shoulder’s labrum, a cartilage ring surrounding the shoulder joint’s socket.
These injuries are particularly prevalent among throwing athletes due to the repetitive overhead motions inherent in sports like baseball and softball.
Management of SLAP tears typically involves either surgical intervention or conservative rehabilitation approaches.
This article compares the outcomes of these two treatment modalities, discusses diagnostic methods, outlines typical rehabilitation courses, and suggests preventive strategies for throwing athletes.
I personally work with a variety of athletes who are coming back from this challenging injury.
Failed surgeries, improper tension of the biceps tendon after anchoring, errors in reloading the arm, and training mistakes all hinder athletes’ abilities to perform at their best.
With a strong diagnostic approach, success is possible. Still, it requires consistent attention to program modification, throwing program workloads, and a ton of focus off the field to ensure habits are always at a premium level.
Buckle up and prepare to slap SLAP tears in the face.
A Quick Intro to SLAP Tears
SLAP tears are quite unique. To my knowledge, only two other tendons in the body connect cartilage and bone: the patellar and quadriceps tendons.
The knee joint is a hinge joint, so the stresses are more planar than multidirectional.
With the labrum of the shoulder, the biceps tendon attaches to it and interfaces with bone. Since the shoulder moves in multiple directions, translates moving around in the joint, and rotates, the biceps tendon is highly prone to twisting and becoming taut.
With heightened tension, the labrum can peel off the bone of the shoulder blade and tear.
This animation will give a better anatomical description.
.
One of the most common mechanisms of this injury is when strength and length are at odds. Players who are hypermobile and lack stability in the shoulder joint are a problem.
On top of that, a tight posterior capsule can lead to a problem called GIRD. GIRD stands for glenohumeral internal rotation deficit, where the internal rotation on the throwing arm side is significantly less than that of the non-throwing arm.
The result is that the humeral head, the ball of the shoulder joint, suctions up and back as the thick posterior capsule causes the arm to migrate higher and further behind the athlete as they transition into maximum layback.
Couple that with a significant amount of layback, the biceps tendon twists, creating considerable tension at the labrum that can cause it to fail.
Orthopedic Testing for SLAP Tears are Pain-Provoking
If you suspect you have a SLAP, the diagnosis is generally subjective at first. If suspected on special tests, you are headed to a good old MRI. They are no fun, and if you are like me, claustrophobia is an issue, but you won’t see the needle go in your arm for contrast dye.
An accurate diagnosis is essential for effective treatment planning. Still, interestingly, the use of a dynamometer (strength testing sensor) is not part of the approach to early detection, but it is most certainly part of the problem before the tear.
Preventing asymptomatic tears from becoming symptomatic is the key, as most baseball players, especially pitchers, have some level of SLAP tearing yet do not experience pain.
These are orthopedic tests commonly employed all attempt to provoke pain in the athlete:
- O’Brien’s Test : The patient flexes the shoulder to 90 degrees with the elbow fully extended and then adducts the arm across the body. The test is positive if pain is elicited during internal rotation but relieved during external rotation.
- Yergason’s Test : The examiner resists supination and external rotation with the patient’s elbow flexed at 90 degrees and forearm pronated. Pain or a snapping sensation in the bicipital groove suggests biceps tendon pathology or a SLAP lesion.
Surgical vs. Conservative Rehabilitation Outcomes
Treatment strategies for SLAP tears vary based on factors such as patient age, activity level, and tear severity.
- Surgical Treatment: Arthroscopic repair is the standard surgical approach, aiming to reattach the torn labrum to the glenoid. Success rates for isolated SLAP repairs range between 74-94%. However, outcomes may be less favorable in patients over 40 or those with concomitant rotator cuff injuries.
- Conservative Rehabilitation: Non-surgical management focuses on physical therapy to strengthen shoulder stabilizers and restore function. Some patients achieve satisfactory outcomes without surgery, mainly when the tear is less severe or the patient is less active.
In the case of baseball pitchers, if you do not have the ArmCare.com platform to guide your conservative or surgical rehabilitation approach, I am praying for you.
You will not know when the function is restored if your arm is overly fatigued if you have joint motion restrictions, imbalances, or poor recovery— not to mention, you will not know if your arm is considered strong in terms of avoiding secondary injury.
Athletes need to work to have greater than 120 ArmScore, in my opinion, to pick up a baseball, have a balanced shoulder, minimal capsule restriction, a high strength-velocity ratio, recover well, and are not susceptible to fatigue.
Preventive Strategies for Throwing Athletes
As mentioned, throwing athletes should regularly test their throwing arms with the ArmCare.com platform to minimize the risk of SLAP tears. It is the pain of discipline or the pain of disappointment, but there will be pain if we do not monitor our throwing arms regularly.
I also highly recommend athletes take our MLB Recovery Habits course. You must do the right things off the field to maximize your arm’s resistance to damage and ability to advance velocity safely. We go through the Great Eight deeply.
- Implement Proper Throwing Mechanics: Ensuring correct techniques reduces undue stress on the shoulder.
- Engage in Strengthening Programs: Focus on the rotator cuff and scapular stabilizers to enhance shoulder resilience.
- Adhere to Pitch Counts and Rest Periods: Following guidelines like those from our individualized pitch count feature helps prevent overuse injuries.
- Incorporate Flexibility and Conditioning Exercises: Maintaining overall shoulder flexibility and conditioning supports joint health.
By adopting these preventive measures, athletes can reduce the likelihood of SLAP injuries and promote long-term shoulder health…but always remember….
Strength Matters Most…. Because it does.
Ryan
Ryan@armcare.com