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SLAP tears are a frequently diagnosed source of shoulder pain. Unfortunately, they are likely over-diagnosed. As I have mentioned before, SLAP tears are a unique type of labral tear. The labrum of your shoulder is a cartilage ring around the socket of your shoulder. At the top of the ring, one of your proximal bicep’s tendons (yes, there are two) is attached. When this top portion of your labrum is torn from the bone of your glenoid, a SLAP tear exists.
One of the problems with this diagnoses is that there is a tremendous amount of variability from person to person in this region of the shoulder. So determining what is abnormal, ie. a tear, from what is a variant of normal is not always easy.
To make things even more difficult, our ability to definitevely diagnose a SLAP tear through an office examination is poor. Typically, SLAP tears will produce pain, often in the front of the shoulder, but sometimes in the back, with overhead motion. But they can also result in pain at rest. Additionally, since bursitis can be found in association with SLAP tears, pain on the side of the shoulder can also be present. As can clicking or popping. Essentially, the symptoms of SLAP tears can look like most other shoulder problems. Sure there are specific tests that can be done in the office that are supposed to clarify if a SLAP tear is present. However, these tests have a tremendous number of false positives and false negatives. And therefore, they are not very specific to this diagnosis.
So what about MRIs? MRIs are very good studies for some problems. But as I have discussed on this page and in this video series before, MRI’s can often be misleading. They can frequently over- and under-diagnose. Consequently “identifying” problems that don’t exist and missing issues that do. This is true particularly when trying to diagnose labral tears, particularly SLAP tears.
Unfortunately, the best method for diagnosing SLAP tears is a shoulder arthroscopy. During this procedure, we can look in your shoulder and touch and analyze the superior labrum firsthand. But even this is problematic. Well-trained and experienced shoulder surgeons often don’t agree on which superior labrum have a tear and what treatment is appropriate when viewing the same videos taken from surgeries.
And if all that wasn’t confusing enough, among these same experienced shoulder surgeons, there is not even a consensus on how to treat these lesions even when we are sure that they exist.
If you think you have a SLAP tear, I’m sure that I haven’t given you much confidence. Hopefully the video below will help clarify things. Watch this latest installment of The Two Boneheads video series, in which Dr. Howard Luks and I discuss this difficult topic. Please let us know if you have any questions.
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