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The labrum is a cartilage structure that circumferentially attaches to the glenoid (socket) of the shoulder. It provides a rounding shape to the otherwise flat socket of the shoulder and helps the socket articulate with the ball, therefore enhancing stability of the shoulder joint. The superior labrum can be damaged by repetitive overuse (overhead athletes, heavy manual labor) or with an acute injury. SLAP (Superior Labrum from Anterior to Posterior) tears occur at the upper region of the labrum where the long head of the biceps tendon attaches. Occasionally there is only mild fraying of this portion of the labrum, while more serious tears involve actual detachment of this portion of the labrum from the bony socket. Depending on the severity of the tear and the physical demands of your lifestyle, labral injuries may or may not require surgery. To be clear, we will aggressively treat your problem to maximize your function but if your lifestyle does not demand high-stress use of your shoulder, surgical treatment may not be appropriate. This is a decision we will make collaboratively with you. Frequently, a nuanced approach to therapy can help even a high-level athlete avoid surgical treatment.
Pain with activity and even night pain can occur with superior labral tears. While many labral injuries can be diagnosed based on a careful history and physical exam, occasionally an MRI is required to confirm the diagnosis or assess the severity of the damage. Many patients with a superior labral tear will achieve a full recovery without surgery. However, patients with higher demands from an occupational standpoint and, particularly, our overhead athletes (baseball, volleyball, tennis) are more likely to require surgical repair if they wish to maintain their high level of activity.
When surgery is required, this is done arthroscopically, typically in an outpatient setting. Our surgeons are on the leading edge of anatomic restoration and reconstruction of the labrum. We have given talks to national and international groups on advanced shoulder arthroscopy.