SLAP lesions and labral tears- Do You Need Surgery?
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- เผยแพร่เมื่อ 17 พ.ย. 2016
- SLAP lesions are very common tears of the labrum, or cartilage disc in the shoulder. Many SLAP lesions are a normal consequence of aging and do not require surgery. Some SLAP lesions are the result of chronic repetitive stress of sports and might benefit from surgery. How do you know which category you fit into?
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Many adults have a labral tear as a normal consequence of aging. Most of these tears are not the cause of your pain and do not require treatment. The pain in your shoulder is usually due to something else.
The most common cause of night pain in the shoulder is the rotator cuff and perhaps a bit of bursitis. Night pain is not often caused by a labral tear.
This article on our site can help you if you require further information. www.howardluksmd.com/educatio...
Excellent information! Thank you very much for sharing.
you guys made my year with this, thanks!
:-)
I get their point on older patients; but for the relatively few who are older AND suffer a SUDDEN injury where prior there was Zero pain, I think its a different conversation...
I’ve had 3 shoulder surgeries due to a torn labrum and it still isn’t right. At this point I’m lost, I live near Albany I might come see you.
Bottom line people is that you should do everything possible before getting surgery. Even these dudes who are super knowledgeable would like to avoid it if possible in almost all cases. Obviously there are exceptions. Learn to care for your shoulders and every way possible and don't get lazy on your physiotherapy. Not saying this will definitely fix things for you but surgery really should be the final option and only done if unavoidable with multiple opinions. I know this is easy for people and can cost a lot of money just to get evaluated properly but just saying. Now if you play quarterback for the 49ers you might want to consider a surgery sooner rather than later... good luck to everybody and making your shoulder Dreams Come true!
Thanks!
I am 19, and had a SLAP repair done when I was 17. My shoulder is still a mess, I actually tore the other shoulder last summer, SLAP lesion as well. I have been to 3 different doctors and 4 different Physical therapist. I dont know what to do anymore
hey I have problems in both my shoulder as well.. I can't drive lol. There are too many things i can't do. I was just thinking maybe no one has the same issues I do (problems in both shoulders) but you do. Anyways, keep me updated
That is the new generation of kids. Wind blows and shoulder fails.
Hunter I feel your pain bro don’t worry ,once upon I used to play lot of sports and gym and I will do lot of gymnastics and calisthenics and also I will do my routine like my classes and so on, but last year 2019 sep 15 I tore my right shoulder labrum ( slap T2 c tear), and after that I strained my left shoulder very much and I feel weakness in both of my shoulder ,I’m totally heart broken .... but here’s one thing my doc said this tear is very small don’t need surgery for this small tear ,just rest and then strengthening phase... if u do surgery means u will damage more area for repairing that small tear like that he told me.....
Did you manage to get rid of the issue?
Well, here is my problem. I can't put my right arm behind my back without hurting. I can kind of extend my right arm above my head but it looks like I'm doing it with my whole body and it can't be straight. When I do sudden movement, let say I have a keys in my hand and they are about to drop and I suddenly move my arm to catch them, I feel the worst pain. It gets so bad that I just freeze up until it stops (maybe 1 minute later). Then when I put my right hand on my stomach, it kind of hurts a little bit, but my arm is not straight (from elbow to my wrist) and I can't seem to make it straight. I can try but it looks like my whole shoulder is moving up, not just arm, but the whole shoulder and even my neck muscles. It just look unnatural. Generally I have good strength. When I press with my left arm my right arm, I can resist quite good. I can feel kind of weakness in the morning in the right arm and hand, but it goes away soon. What could this be? Is it tear or something else?
I'm 41 with a SLAP tear but the problem with me is instability. I have subluxation when reaching across my body and sometimes above my head. I also cysts present.
16-18 years ago, I was doing incline press weightlifting and I had this pained in my right shoulder and back. I couldn’t let my arm down below shoulder level without every muscle in my shoulder spasming. I couldn’t sleep but an hour or two at a time without waking me up in pain. I gave it a few months and it finally settled down but have had a problem every since that if I reached behind myself I would have every muscle in my shoulder tighten up. About 6-7 months ago I moved a heavy treadmill and had pain in my shoulder that has consistently gotten worse. My ortho sent me to have an arthrogram MRI and it was one of the most painful things I have ever experienced . By the way, I paid for the MRI because my insurance wanted me to go through 6 weeks of therapy first. The diagnosis from the MRI was a SLAP Tear of my Labrum involving the biceps anchor. Also the following, 1. Extensive marrow edema with confluent T1 hypointense signal in the distal acromion and distal clavicle. Moderate inflammatory change surrounding the acromioclavicular joint and moderate acromioclavicular osteoarthrosis. Findings could reflect septic arthritis of the acromioclavicular joint with osteomyelitis, although there is no significant joint effusion. Inflammatory arthropathy such as rheumatoid arthritis is an alternative consideration. Osteolysis of the distal clavicle secondary to repeated microtrauma would not be expected to have abnormal signal in the distal acromion. Can you help me understand what this means and what my options are. I don’t have the funds for a second opinion but need some words of wisdom before I go see my ortho surgeon.
Many thanks guys! I have SLAP tear and partial superspinatus detatchment in my right shuolder.I'm 35 and have shoulder pain for almost five years now.I'm not a pro but i was very active for over 10 years (gym,MTB,motocross).I've always had other health issues that might caused faster labrum/tendon degeneration and my pain was progressing during the years.My left shoulder have some issues too same as my spine and pain in the neck (bad posture and problems with my spine from my childhood).Now i'm waiting for surgery but I'm waiting for second opinion from my other doctor too.I have to make sure that it will be safe for me to do this kind of surgery.I have thyroid,astma and liver problems and I'm taking some antidepressants for almost 5 years now so few meds that can affect my surgery and recovery progress.My shoulder hurts when i pick up something heavier in bad angle or when i'll try to bench press (i don't do it anymore of course).I'll be appreciate for any advice but if you don't have time for this it's not a problem.Just want to thank you for your free videos.Every advice is pricefull for me.Cheers guys!
Im double jointed in my right shoulder so instability in the joint was always there. I have grinding/clicking in the back of the shoulder and i was getting discomfort in the bicep tendon but now it’s gone away. Im also a powerlifter, should i consider an MRI to be safe?
I was very happy to see this video. Thank you for posting this information. I postponed SLAP repair surgery last month. I'm a 48 year old tennis player and experience pain across the back of my scapula when serving. An MRI indicated a SLAP lesion and my surgeon suggested surgery was the only way to return to activity. I have full motion and reasonable strength, and don't experience instability. Pain is worse at night after overhead activity and can last a week or more if aggressively used. Your video talks about young overhead athletes who might be candidates for surgery and over 40 individuals with what's likely normal pathology as not being candidates. What are your thoughts on over 40 year old overhead athletes? Thanks again! Colin
Did I get it right that if a simple bicep tenodesis WITHOUT labrum repair is better than WITH labrum repair in case of athletes below 30?
I´m 25, I lift, got a SLAP on my MRI, have no idea if i should have it fixed and if so, only the bicep tendon should be reattached or also the superior part of the labrum fixed.
Does, according to literature or medical experience, a SIMPLE TENODESIS have better results than a tenodesis with labrum fix in young athletic patients?
Or I got the message wrong?
Stiffness of the shoulder after a labrum repair? I have a seriously unstable shoulder.
At 58, I was diagnosed with a slap tear after a rear-end automobile accident. My car was sitting in traffic and hit from behind by a pick-up truck. I first went to a chiropractor, then the ortho doctor who prescribed a treatment of physical therapy. The PT did not help, so now I am on a muscle relaxant while awaiting surgery. The symptoms seem to wax and wane and move about. Usually, the pain is worse in my neck. Sometimes the back of my shoulder hurts more, and occasionally my arm from the shoulder to the elbow hurts a lot. There are times when I cannot abduct my arm more than a few inches from my body and other times when the range of motion is not bad. I don't know whether to get the surgery. I will have to pay out-of-pocket and hope the other driver's insurance company pays me back in the settlement. I can't decide what to do. Any thoughts?
D. R. Greg I know this is way late but have you had any success with your situation?
35 yo male who did a lot of overhead pressing. Also took a couple of falls with my bicep strained (unrelated to overhead pressing). Diagnosed with superior labral tear. Have symptoms of dull pain in my tricep close to my elbow. My question for everyone is do you guys with tears also have symptoms far away from the shoulder or is it probable that my bicep also messed up at the other end too?
Absolutely! When ligaments are involved nerves get all befuddled as to the source of pain. Nerves go THROUGH ligaments and bones. Nerve ENDINGS report pain.
I have a tear in right shoulder, damage to c4,5,6 and arthritis in my right shoulder. I hurt.
Being misdiagnosed is far too common. Problem is, opinions vary even among specialists in the same specialty. While MRI resolution has increased, specialists and M.D. that read MRI's still want to see Arthogram using toxic contrast injections of Galodinium. Manganese and Iron have been suggested as safer alternative contrast agents, but still are not mainstream in use.
Just has that done with GAD. ....
Any information on the other doctor?
Thank you doctors for this great video, I have a slap lesion tear in both shoulders in my right shoulder it’s from 2/12 I’m 42 this injury occurred over 10 years ago now, my bicep sometimes feels like it’s tearing also, is surgery of any benefit , also what can I do for my bicep tearing pain? Thank you I hope to get any type of response
HI.... Most bothersome SLAP lesions in folks in their 40s will manifest as biceps symptoms. The biceps will often degenerate, or partially tear if a SLAP lesion is large enough. There are surgical remedies for this (biceps tenodesis) if your surgeon feels that the biceps is the cause of your pain. There has been a trend away from high biceps tenodeses or arthroscopic tenodeses ... and many feel that the subpectoral tenodesis is the way to go. Talk to a good shoulder doc to find out.
Howard Luks thank you for taking the time to respond.
My daughter is 15 and has a slap tear but can still do most things. She does have pain but it’s off and on. I don’t want her to do surgery at all but I’m not her and I don’t know the pain. Should we focus on strength training? Or go for the surgery. I’d hate for her to have more pain after.
I’m 16, and I play volleyball. Working towards playing in college. I’ve had clicking and popping in my shoulder for about a year, but it only happened every once in a while, and it didn’t hurt me. But for the past 3-4 months it’s gotten a lot worse. It pops out, and clicks/locks every time I move it. I play club and school vball, and the athletic trainer at my school said there’s a possibility I’ve torn my labrum. I’m still playing through it, waiting until July, when my club seasons over. Then I’ll go to the doctor. I’m starting to think that I actually might need surgery, and I’m scared bc I don’t want to lose that 4-6 months afterwards
Did you end up having a tear and having surgery?
Hi Docs. this is one of the BEST analysis i have heard so far on the SLAP tear. thank you very much... greatly appreciated
I am 38 and i have SLAP tear 11-2 position which was diagnosed when i was 34. I am a tennis player and i am very sure that the pain and instability in my shoulder (especially after serving) is because of the SLAP tear (tried many different ways to prove it) . I tried many Physical therapies and strengthening by internal rotation of shoulder and totally avoiding reaching backwards has helped so far to avoid pain...
Now Qs - I do not want to do surgery but if i DO the surgery what are my chances of getting full strength with full motion?
I do not have any other probs in my daily life because of the SLAP tear except limitations in tennis. So always debating if i should take my chance of fixing it?
What did you do in the end? I had the same dilemma
@@yinghan9509 me too!
So I was told I have a Slap Tear 11 o’clock and 8-9 o’clock and my bicep is very tender I have pain n that spot also my whole arm to my fingers goes numb and cold which doesn’t feel like it belongs to me. Also my elbow always catches now which is weird idk if that has anything to do w the slap tear or the bicep anyways should I have the surgery? Now the Dr told me my arm is coming off my shoulder and I needed surgery. I’m 47 yrs old and would like to have another opinion. U both stated if u r over 40 theirs no need for surgery. Please get back w me before November 18th 2020 that’s when the surgery starts. Thank u for reading.
Hi Docs,
Last month i had an injury while training Over head dumbbell pull overs at the gym and both my shoulders almost popped outta the joint. i went to see the doctor couple weeks after the injury and they took x- rays and the results were fine. Then i was assigned to certain physical examinations and the surgeon told me that i should do an MRI on the right shoulder because the pain at that time was quite severe on the right compared to the left.
the MRI showed a slap lesion on my shoulder and the doctor told me SLAP repair will be the best option considering my athletic training and involvements in exercising. I'm 23 years old. I've been off the gym for quite sometime now and this is mentally dissatisfying. i still feel pain on my left shoulder it didn't wear off its almost one month after me being injured..
any thoughts about the surgeon's decision? and please tell me the complications that i will have after the surgery.?
Thanks in advance..
Hoping to hear from you soon
Hey man, we are the same age and also have the same injury. Did you go with surgery or started PT?
This is dynamite near the same issues I have had. My shoulders just seem to be very fond of flexibility in the overhead positions like the pullover.
I always managed to handle the instability with only a rare dislocation in the past..
But now I'm 28 and more committed to training. Ten kilo dumbbell pullovers didn't cut it; I trained for the front lever.
My arm has popped out of socket twice now and I just had a painful O'Brien's test.
From my youtube scourge tonight . . . I guess the answer for us unstable shoulder people is to make really slow gains in that range of motion of the lat.
If it isn't overhead the arm is still stable, so we can still hit the lat.
Heavy (when ready) band work for the stabilizing muscles makes sense.
For the weak range of motion: higher frequency, enough rest between sets and low weight.
Hi
I am Praveen from Delhi India ,
I AM 50 and play badminton ,
As per my MRI I have a SLAP tear in my playing shoulder (right),
I want to restart playing at the earliest and also want to avoid any surgery
As per my ortheopad I must avoid playing in future even after surgery ,need your valuable inputs ,
Will I be able to play again ?
I know this is a little late but I was just rear ended on the freeway a couple of months ago by a drunk driver and my truck shot across 3 lanes, slammed into a bridge wall on the freeway, did a 360 and landed and finally did a partial roll over. I just found out I have bilateral slap tears in my shoulder and I’ve been having really bad neck and back pain since the accident. I also have a small cyst in one shoulder and bursitis. I have random numbness/tingling sensation in my left and right finger tips as well and extremely weak if I try to pick anything up more than a couple pounds. I also have a couple disc bulges in my lower back that measure 3mm I believe. Do you think this is something that PT will help or would I be a candidate for surgery since I’m only 31 and was very active before (hiking, camping, mostly home body workouts 3-4 times a week.) just going up one flight of stairs to my apartment is a struggle now and always ends with more pain and shortness of breath. My Chiropractor has recommended PT but I’m just worried that it’s just to make more money off of me since I have a lawyer and in the end he’ll just say I need the surgery anyways. (He has an ortho specialist that he works with as well.) Any advice would be greatly appreciated.
Forgot to mention I also have occasional numbness/ tingling sensation in my right and left feet as well that randomly comes about that I didn’t have before. I also have throbbing/ stinging sensations that radiates down from my glutes down to both of my legs.
Thanks for your video! I'm 54 with a SLAP tear type 2 according to my MRI. I also have various tendonitis. I have trained in the gym and at boxing all my life. My shoulder is in pain, although bearable, and can't do certain exercises without increasing the pain. Would I be a candidate for surgery or simply physiotherapy? Thanks again!
I am 52, been weight lifting, kick-boxing and swimming for many years. I developed shoulder issues last year, which have grown worse since to the point where I cannot do any of the above. But this is just the point, all my major activities have been very hard on the shoulders, never giving any break, constantly pushing. The lesson I am learning from this is to step back, calm down, relax and let my body heal itself.
So when is an MRI useful? You gave several instances where the MRI has difficulty discerning a tear compared to some other anomaly.
Also you seem steadfast of doing surgery for almost any reason if it's an "athelete" but in a patient 50's and 60's the reason for almost any problem in the shoulder is that its degenerative and those patients should just deal with it because these problems come with advancing age.
I dont know about anyone else but even though I'm 58 and pushing 60 I'm not just going to sit around and give up an active lifestyle just because I have issues such as tears in my shoulder or even a bone spur which was seen on x-ray which could be slowly shredding one of the tendons.
You seem to skip over the possibility that a person in their 50's or 60's may have had an injury which is my case. I fell over a year ago and still having problems. Would your thinking change at all for this type of person as far as having some type of surgical intervention but only just an MRI which you dont seem to have much faith in as far as giving a good and trustworthy diagnosis. In that case what type of study do you recommend then to get a diagnosis. Because I've never heard of a surgeon who can accurately diagnose any anomaly in the shoulder without an MRI or even a "test" which you dont seem to have much faith in either. And Im sure youre' going to say those tests are only an aide to diagnosing the problem.
So basically about the only time you would consider surgery is if the patient was an "athelete. Then get them onthe schedule for the next day. But if its Suzy whose just turned 60 her problems are most likely just old age and she doesnt need to enjoy a healthy active life style in her senior years only an just that its so important to keep an athelete in top notch shape. I think thats a very biased way of thinking. Would you change your opinion if the old patient actually landed on their shoulder 200 lbs of dead weight which was my case. My surgeon feels I have good strength but when you think about when I do have the episodes of pain, I really don't have good strength at that time. That's pretty much common sense. Don't you agree?
How do you stay in practice if you only operate on what seems to be one group of patients? Because you dont make any money sending those old people to PT or is it risky as in youre afraid of the liability and dont care about making all types of patients from all backgrounds get some kind of relief from their shoulder difficulties and maybe even have complete relief from surgery not from Mother Nature. I also didn't like or appreciate your comment if you just send the old person to PT or give them an injection,the longer you let the condition continue without even scoping them, their problem will go away. So what youre saying is that the old fogies are just making this up and dont really have anything going on for you to consider a more surgical intervention than just PT or injections. That is my opinion.
J Louis... Kudos for staying active!! We encourage older folks to stay active.. and we want to help them just as much as we help younger athletes. The point that we were making is that SLAP lesions are very commonly seen on an MRI of the shoulder in most people over 45-50 years old. That likely means that we develop SLAP tears or degeneration because some of our parts wear out. That does not mean that we won't occasionally run into someone such as yourself who had an injury and perhaps caused that tear to worsen. We routinely recommend an MRI if non-surgical treatments such as PT have not been able to improve your pain. The most important message to take away from this is that even if your MRI shows a SLAP or labral tear, the cause of your pain might be because of the biceps, the rotator cuff or the bursa. These are very, very common causes of pain in us older athletes.
Again ... we will often order an MRI to confirm a diagnosis, regardless of age, in anyone who has shoulder pain that is interfering with their quality of life and has not responded to medications, PT, etc. We definitely do not discriminate ... aging athletes are our favorite group of people to deal with. They are highly motivated people! :-)
I have a loud clicking and popping sound in my left shoulder and the humerus seems to slightly move out of place if I put my hand in my back and push my elbow forward. I recently had an MRI and the readings said I had nothing and everything was in its place. The pain isnt too significant bit I do feel the area somewhat weak and my tricep occasionally hurts a little. I'm 25 and I used to do olympic lifting but I had to stop as a result. Is this a sign of a SLAP tear? If so should I stick to PT and rehab exercises to strengthen the area or should I opt for surgery?
I am wondering if maybe the mri missed your tear if its a small tear its possible I still have a tear and the mri missed it rehab did nothing for me because I would still play the sport that required over hand swing however it may be worth a try if you don't do any sport that requires it or any job that puts strain on it
A good exam, and perhaps an MRI with contrast, or a second opinion on your MRI will help (those are available online). PT is often effective, and should be trialed before considering labral surgery for shoulder pain.
Would you fix a ucl tear in a 42 year old pro bowler full tear
great question... would try rehab, etc to avoid it.
Thank you Dr
BS. So, if you are over 40 just live with the pain because it is normal. I am 50 and VERY physically active. I got a SLAP lesion from doing overhead dumbbell thrusters. It is a clear injury. But according to your logic I am done now.