Labrum Tear Treatments

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. ¹ Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. The Recognition and Treatment of Superior Labral (SLAP) Lesions in the Overhead Athlete.International Journal of Sports Physical Therapy. 2013;8(5):579-600.

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. ¹ Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. The Recognition and Treatment of Superior Labral (SLAP) Lesions in the Overhead Athlete.International Journal of Sports Physical Therapy. 2013;8(5):579-600. A different study argues that nonsurgical treatment could be successful in a small portion of patients—primarily those with type I SLAP tears, ² Dodson CC, Altchek DW. SLAP Lesions: An Update on Recognition and Treatment. Journal of Orthopedic & Sports Physical Therapy. 2009; 39: 71 - 80. 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 Dodson CC, Altchek DW. SLAP Lesions: An Update on Recognition and Treatment. Journal of Orthopedic & Sports Physical Therapy. 2009; 39: 71 - 80.
• 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. ³ SLAP tears. American Academy of Orthopedic Surgeons Website. http://orthoinfo.aaos.org/topic.cfm?topic=A00627 Updated August 2011. Accessed March 24, 2016.

SLAP Tear Surgery
Arthroscopic surgery is the most common surgical technique. The surgeon evaluates the labrum and biceps tendon during this procedure. ⁴ 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.

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. ⁵ Treuting R. Minimally Invasive Orthopedic Surgery: Arthroscopy. The Ochsner Journal. 2000;2(3):158-163.

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. ³ SLAP tears. American Academy of Orthopedic Surgeons Website. http://orthoinfo.aaos.org/topic.cfm?topic=A00627 Updated August 2011. Accessed March 24, 2016. It is uncommon to have complications from arthroscopic shoulder surgery, ³ SLAP tears. American Academy of Orthopedic Surgeons Website. http://orthoinfo.aaos.org/topic.cfm?topic=A00627 Updated August 2011. Accessed March 24, 2016. 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. ³ SLAP tears. American Academy of Orthopedic Surgeons Website. http://orthoinfo.aaos.org/topic.cfm?topic=A00627 Updated August 2011. Accessed March 24, 2016.

While it typically takes about six months for the shoulder to completely recover from surgery, ⁶ 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. most patients develop full use of the shoulder following labral surgery.