Nonsurgical (conservative) and surgical treatment are two approaches for treating a SLAP tear, or a labral tear in the shoulder. It is most common for physicians to treat a labral tear with nonsurgical techniques first, before turning to surgical options. Above all, treating a SLAP tear is important to prevent possible long-term pain and a decrease in shoulder activity.5

There are several options to consider for each treatment method.

Nonsurgical SLAP tear treatment
Nonsurgical treatment is normally recommended first to treat SLAP tears, but opinions vary on the success of this regimen. One study found that this treatment is usually ineffective, especially in patients with type I or IV SLAP tears.5 A different study argues that nonsurgical treatment could be successful in a small portion of patients—primarily those with type I SLAP tears,2 where the labrum is frayed, but not detached.

Nonsurgical treatment includes:

  • Termination of throwing activities. Since SLAP tears can be found in athletes engaging in overhead and throwing activities, elimination of these actions is usually the first recommendation.2
  • Anti-inflammatory medications. Medications such as ibuprofen may be taken to decrease swelling and pain.
  • Physical therapy exercises. A doctor or physical therapist may assign certain exercises to strengthen shoulder muscles and improve shoulder motion through stretching. This type of program could carry on for three to six months.4

SLAP Tear Surgery
Arthroscopic surgery is the most common surgical technique. The surgeon evaluates the labrum and biceps tendon during this procedure.8

See Treating Frozen Shoulder

This surgery is favored because small incisions are made, instead of the larger ones that open surgery requires. As a result, patients experience less swelling and discomfort and start the healing and recovery processes sooner.9

See Shoulder Decompression: Arthroscopy vs Open Surgery

Surgical options vary depending on the type of SLAP tear and patient factors: including age, activity level and concomitant injuries, if any.4 It is uncommon to have complications from arthroscopic shoulder surgery,4 but any surgery has potential risks and complications. Stiffness, bleeding and nerve or blood vessel damage are a few of the possible difficulties with arthroscopy.

Post-Operative Management
There are specific steps to follow after SLAP tear surgery. While procedures vary—depending on the type and severity of the tear—there are a few broad management guidelines to keep in mind:

  • A sling is used for the first several weeks after surgery. A physician may also prescribe mild exercises.
  • Exercises to gain motion and flexibility as well as shoulder strengthening exercises are added over time.
  • Normally athletes involved in throwing sports can begin interval throwing three or four months after surgery.4

While it typically takes about six months for the shoulder to completely recover from surgery,10 most patients develop full use of the shoulder following labral surgery.

References

  1. Shoulder Labral (SLAP) Tear & Repair. New York Bone and Joint Specialists website. https://www.nyboneandjoint.com/articles/shoulder-labral-slap-tear/ Accessed March 30, 2016.
  2. Treuting R. Minimally Invasive Orthopedic Surgery: Arthroscopy. The Ochsner Journal. 2000;2(3):158-163.
  3. Arthroscopic Labrum Repair of the Shoulder (SLAP). Sports Medicine Massachusetts General Hospital Orthopedics. http://www.massgeneral.org/ortho/services/sports/rehab/Superior%20labrum%20anterior%20and%20posterior(SLAP)rehabilitation%20protocol.pdf Accessed March 25, 2016.
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