What is the treatment for a slap tear along the labrum of the shoulder?

Treatment of SLAP Tears

Initial conservative management with physical therapy, activity modification, and anti-inflammatory medications is the recommended first-line treatment for SLAP tears, with surgical intervention reserved for cases that fail non-operative treatment after an adequate trial period. 1, 2

Initial Diagnostic Workup

• Obtain standard radiographs with three views: anteroposterior (AP) in internal and external rotation plus an axillary or scapula-Y view to rule out fractures and assess alignment 1, 2
• MR arthrography is the gold standard for confirming SLAP tears, particularly in patients under 35 years of age 3, 1, 2
• Non-contrast MRI is appropriate if radiographs are negative or indeterminate and MR arthrography is not immediately available 1, 2

Conservative Treatment Protocol (First-Line)

Most soft-tissue injuries including labral tears can undergo a period of conservative management before considering surgery. 3

Physical Therapy Components:

• Rotator cuff strengthening exercises targeting supraspinatus and external rotators 3, 2
• Periscapular muscle strengthening, particularly serratus anterior to address scapular dyskinesis 3, 2, 4
• Core musculature strengthening 3, 2
• Capsular flexibility exercises 3, 2
• Soft tissue mobilization for trigger points in rotator cuff, biceps, rhomboids, and serratus anterior 4

Expected Outcomes:

• Conservative treatment provides symptom relief in approximately two-thirds of patients 5
• Success rates reach 71.4% at average 21-month follow-up with significant improvements in pain and function 6

Predictors of Conservative Treatment Failure

Patients with the following characteristics are less likely to succeed with non-operative management and should be counseled accordingly:

• History of acute trauma rather than insidious onset 6
• Positive compression-rotation test on physical examination 6
• Participation in overhead activities or throwing sports 6
• Mechanical symptoms suggesting instability 6

Surgical Indications

Surgery should be considered when:

• Conservative treatment fails after an adequate trial (typically 3-6 months) 1, 2
• Recurrent labral tears causing symptomatic instability 7
• Young, active patients with clear traumatic etiology and instability symptoms 5

Surgical Options by Patient Population:

For patients under 40 years with traumatic injury and instability:

• SLAP repair without biceps tenotomy/tenodesis 5

For patients over 40 years with traumatic injury:

• SLAP repair with consideration of biceps tenotomy or tenodesis 5, 8

For patients with overuse etiology without instability:

• Biceps tenotomy or tenodesis preferred over SLAP repair 5

For throwing athletes:

• Rigorous physical therapy centered on hip, core, and scapular exercise with restoration of shoulder motion and rotator cuff balance 5
• SLAP repair reserved only for those who fail comprehensive rehabilitation 5
• Results in throwing athletes are less successful with significant numbers not regaining pre-injury performance level 9, 8

Post-Surgical Rehabilitation

After SLAP repair, throwing athletes must:

• Avoid throwing for minimum 6 weeks post-surgery 3, 2
• Complete strengthening phase for additional 6 weeks (total 3 months rest from throwing) 3, 2
• Base return to sport on functional testing rather than arbitrary time points 2

Critical Pitfalls to Avoid

• Do not confuse labral tears with rotator cuff pathology - these are fundamentally different entities requiring distinct treatment approaches 7
• Do not use subacromial injections - evidence for corticosteroid injections is specific to rotator cuff tears, not labral pathology 7
• Do not delay surgery in young, active patients with recurrent instability where conservative management has already failed 7
• Do not rush to surgery in overhead athletes - these patients have unpredictable return-to-play rates and should exhaust conservative options first 9, 5
• Distinguish normal anatomic variations from true SLAP lesions to avoid overtreatment, particularly in middle-aged and older patients 8