Understanding SLAP Tear

The shoulder is a complex joint comprising three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The glenoid labrum is a ring of cartilage that surrounds the shallow socket of the scapula, called the glenoid. This labrum deepens the socket, providing stability to the ball-and-socket joint.

A SLAP tear refers to a “Superior Labrum Anterior and Posterior” tear, which occurs in the upper part of the labrum where the biceps tendon attaches.

Causes

SLAP tears can result from:

1. Repetitive Overhead Movements: Common in athletes such as baseball pitchers or swimmers.
2. Trauma: Falling on an outstretched arm or a direct blow to the shoulder.
3. Degeneration: Wear and tear due to aging.
4. Sudden Force: Heavy lifting or rapid pulling motions.

Symptoms

• Deep shoulder pain, particularly during overhead movements.
• Clicking, popping, or catching sensations in the shoulder.
• Weakness or instability in the shoulder.
• Difficulty performing daily activities or sports.

Risk Factors

• Sports Participation: Athletes involved in overhead sports.
• Age: Increased likelihood with advancing age.
• Occupational Hazards: Jobs requiring repetitive shoulder use.
• Previous Injuries: History of shoulder instability or trauma.

Diagnosis

Diagnosis typically involves:

• Clinical Examination: Special tests like the O’Brien test or Speed’s test.
• Imaging: MRI with contrast for detailed visualization of the labrum.

Role of Physical Therapy

Physical therapy is pivotal in managing SLAP tears, either as a primary treatment option or as part of post-surgical rehabilitation. The primary goals include:

1. Pain Reduction: Utilizing modalities like ice, heat, and ultrasound to manage pain and inflammation.
2. Restoring Range of Motion: Gentle stretching and mobility exercises to improve joint flexibility without stressing the injured labrum.
3. Strengthening Surrounding Muscles: Targeting the rotator cuff, deltoid, and scapular stabilizers to enhance shoulder support and prevent further injuries.
4. Improving Shoulder Mechanics: Focusing on correcting movement patterns to avoid aggravating the injury.
5. Functional Training: Gradual progression to sport-specific or occupational movements to ensure a safe return to activities.

Step-by-Step Exercises

Phase 1: Pain Management and Mobility Restoration

1. Pendulum Swings:
   • Lean forward, letting the affected arm dangle.
   • Gently swing the arm in small circles.
   • Perform for 1-2 minutes.
2. Passive Shoulder Flexion:
   • Lie on your back holding a stick with both hands.
   • Use the unaffected arm to lift the injured arm overhead.
   • Repeat 10-15 times.
3. Scapular Retraction:
   • Sit or stand with arms at your sides.
   • Squeeze your shoulder blades together.
   • Hold for 5 seconds, repeat 10-15 times.

Phase 2: Strengthening

4. Theraband External Rotation:
   • Attach a resistance band to a stable object.
   • Hold the band with the injured arm, elbow bent at 90 degrees.
   • Pull the band outward, keeping the elbow close to your body.
   • Perform 2-3 sets of 10-15 reps.
5. Wall Push-Ups:
   • Stand facing a wall, hands shoulder-width apart on the wall.
   • Slowly bend your elbows to lean toward the wall, then push back.
   • Repeat 10-15 times.
6. Closed-Chain Stabilization:
   • Place both hands on a stability ball on a table.
   • Gently roll the ball in circles or forward/backward.
   • Perform for 1-2 minutes.

Phase 3: Advanced Strengthening and Functional Training

7. Overhead Dumbbell Press (if pain-free):
   • Use light dumbbells.
   • Press weights overhead while keeping proper form.
   • Perform 2-3 sets of 10-12 reps.
8. Plank with Shoulder Taps:
   • Get into a plank position.
   • Tap your opposite shoulder with one hand, alternating sides.
   • Perform for 30 seconds to 1 minute.
9. Medicine Ball Throws:
   • Stand a few feet from a wall.
   • Throw a medicine ball against the wall using an overhead motion.
   • Repeat 10-15 times.

Prevention

• Proper warm-up and stretching before activities.
• Strengthening rotator cuff and scapular muscles.
• Avoiding repetitive overhead motions without adequate rest.

Conclusion

A SLAP tear can significantly impact daily activities and athletic performance. Physical therapy plays a vital role in recovery, emphasizing pain relief, mobility, and strength restoration. By following a structured rehabilitation program and incorporating preventive measures, individuals can return to their activities stronger and more resilient.

References

1. Kibler, W. B., & Sciascia, A. (2015). “Current Concepts: Scapular Dyskinesis.” British Journal of Sports Medicine.
2. Wilk, K. E., et al. (2013). “Rehabilitation of the Overhead Athlete’s Shoulder.” Sports Health.
3. Clinical Orthopaedics and Related Research. “The Role of Physical Therapy in SLAP Tear Rehabilitation.”