Supra Labral Tears of the Shoulder by Dr. Gregg Foos

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Dr. Foos: Hi, this is Dr. Greg Foos. I'm here today to talk to you about superior labrum tears. These are otherwise known as SLAP lesions, and we'll give you a little insight as to what this is and what we do with it. The labrum is a flap of cartilage that surrounds our shoulder. We may . . . Most people know that the ends of our bones are covered with cartilage, that's articular cartilage. So, if I hold this up, this is a shoulder joint, and this is the shoulder itself moves around, both the ball and the socket are going to be covered with articular cartilage. But there's a second type of cartilage in our shoulder called the labrum. The labrum is a flap of cartilage that surrounds the socket. So, on the socket portion of it, it comes completely like a clock, from 1:00 all the way around to 12:00 as a flap of cartilage. That flap of cartilage is very important because it serves as the attachment point for a lot of things inside your shoulder. The ligaments that kind of hold our shoulder into place all attach into that labrum as well as our biceps tendon. So this kind of rope right here is your biceps tendon. That will attach deep down into the labrum of your shoulder. This oftentimes can become problematic particularly in certain types of athletes, overhead athletes, tennis players, throwers, swimmers. That overhead positioning and the pull of the biceps tendon can damage the superior labrum. So a SLAP lesion is a tear to the superior labrum which is at the top of the shoulder where the biceps attaches. In those situations, the labrum can become torn.

Now, there are several different types of tears, and these tears are oftentimes difficult for us to ascertain on both clinical examination and even MRI can be very difficult to tell different types of tears apart. The four major types of tears though are split into the way we treat them. A Type 1 and a Type 3 tear are tears that can be treated surgically by looking in there with a camera, finding the torn portion and resetting that flap of cartilage that's catching inside the shoulder joint. In the case of Type 2 and Type 4 tears, those are a little trickier. Those times often . . . those tears will oftentimes need to be treated with repairs so that means that the labrum has to be repaired back its natural state. We can do that also arthroscopically, through small incisions but with a combination of suturing techniques that allow us to put this back into place.

Now I did say that these tears are occurring mainly in overhead athletes; certainly, there is an older population that will wear out the labrum and get degenerative tears of the labrum. These are a little bit trickier to diagnose. Certainly, they can be associated with painful catching inside the shoulder joint and can be treated similarly with arthroscopic techniques to clean up those types of tears or in some cases to repair them.

So superior labrum tears, in general, are cartilage tears inside the shoulder joint. Oftentimes, they involve a detachment of that flap of cartilage and depending on the type of tear, which we can typically diagnose at surgical treatment, determines the type of treatment whether it be a cleanup or repair of the labrum. Most patients with labral tears do very well. These are tears that when treated properly can oftentimes be associated with reduced . . . reduction of pain and actually getting patients back to playing their sports, whether it be overhead activities or even throwing in a pretty quick fashion, usually within two to three months.

So, hopefully, this will help you a little bit with regards to your understanding of the shoulder and in particular the labrum and SLAP lesions. Thank you very much.

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