SLAP Tear Specialist Referral
A patient with a SLAP tear should see an orthopedic specialist, specifically an orthopedic surgeon with sports medicine expertise. 1
Rationale for Orthopedic Referral
SLAP (Superior Labrum Anterior to Posterior) tears are structural injuries to the shoulder joint requiring musculoskeletal expertise for both diagnosis and management. Orthopedic surgeons, particularly those with sports medicine training, are specifically trained to manage sports injuries including SLAP tears, meniscal tears, cartilage injuries, and shoulder instability. 1
Why Not Rheumatology?
Rheumatology specialists focus on inflammatory and autoimmune conditions affecting joints, such as:
- Ankylosing spondylitis and axial spondyloarthritis 1
- Inflammatory arthritis requiring disease-modifying antirheumatic drugs (DMARDs) 1
- Systemic inflammatory conditions 1
SLAP tears are mechanical/traumatic injuries to the labral cartilage and do not involve systemic inflammation or autoimmune processes that would warrant rheumatologic evaluation. 1
Orthopedic Management Pathway
Initial Conservative Management
The orthopedic specialist will typically begin with:
- Physical therapy focusing on rotator cuff and periscapular muscle strengthening 2
- Core musculature strengthening and capsule flexibility exercises 2
- Activity modification and anti-inflammatory medications 2
- Conservative management is successful in approximately two-thirds of patients 3
Surgical Considerations
If conservative treatment fails after an appropriate trial (typically several months), the orthopedic surgeon can offer:
- Arthroscopic SLAP repair for younger patients (<35-40 years) with traumatic tears 3, 4
- Biceps tenodesis or tenotomy for older patients (>35-40 years) or overuse injuries 3, 4
- Treatment decisions based on patient age, activity level, mechanism of injury, and associated pathology 5, 3, 4
Diagnostic Imaging Expertise
Orthopedic surgeons work closely with radiologists to interpret:
- MR arthrography (gold standard for SLAP tears) 1, 2
- Standard shoulder radiographs with three views (AP internal/external rotation and axillary or scapula-Y) 1, 2
- CT arthrography if MRI is contraindicated 1, 2
Common Pitfall to Avoid
Do not delay orthopedic referral by first seeing rheumatology. This creates unnecessary delays in appropriate treatment and may prolong patient suffering. SLAP tears require mechanical assessment and potential surgical intervention that only orthopedic surgeons can provide. 1, 2