Are SLAP Tears Abnormal?

MRIs Can Detect Findings That May Be Normal

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SLAP tears are a specific type of injury to the shoulder joint.  Inside the shoulder is a ball-and-socket joint--the shoulder is an amazing joint as it allows for more mobility than any other joint in the body.  In order to allow for such a wide range of motion, the shoulder has a flexible type of cartilage that surrounds the socket of the joint.  Instead of having a deep socket of bone (which would restrict mobility), the shoulder's socket is a flexible type of cartilage called the labrum.

The labrum is a thick tissue that is firmly attached to the bone of the shoulder socket.  The labrum deepens the socket to keep the shoulder in proper position.  Sometimes the labrum can be damaged when people sustain a shoulder dislocation.  The most common type of injury when someone dislocates their shoulder is called a Bankart tear.

SLAP Tears

Another type of injury to the labrum is called a SLAP tear.  SLAP stands for "Superior Labrum from Anterior to Posterior."  Essentially, the SLAP tear means the top of the labrum is damaged.  This is an important part of the labrum as it is the location of the attachment of the biceps tendon in the shoulder.

Most often SLAP tears are the result of a chronic overuse condition, although they can also occur as acute injuries.  Typical symptoms of a SLAP tear are pain in the front of the shoulder, weakness with certain overhead movements, and a popping or clicking sensation in the shoulder.

Typically, patients are diagnosed with a SLAP tear when they have an MRI as a result of shoulder pain.  The MRI is a very sensitive test, and can allow your doctor to see the condition of your labrum with significant detail.

Is a SLAP Tear on MRI Abnormal?

The challenge is, often a SLAP tear is seen on MRI when the labrum may not be the source of the problem.

  As we age, the appearance of our bodies changes.  For example, we may get a few grey hairs, loose some hair, or notice wrinkles in our skin.  These changes occur on the outside of our bodies, and while we may not like them, we understand they are part of aging.  However, something similar happens on the inside of our body.

Just as the appearance of our body changes on the outside, we also expect changes on the inside.  A recent study investigated MRIs of patients with no shoulder pain or injury.  In patients age 45-60, almost 75% were noted by the radiologiston their MRI to have a SLAP tear.  This should make use pause and determine if the SLAP tear may just be a normal appearance of the shoulder.

What To Do?

This can be confusing for patients: Is a SLAP tear abnormal or not?  Well, it's complicated.  We expect abnormalities of the labrum as we age, and often these abnormalities are interpreted as tears.  What we know is this: abnormalities are less common in younger patients, so in patients younger than 30, SLAP tears are relatively uncommonly seen on MRI. 

As we age, even in our 30s and more so into our 40s, labral abnormalities become increasingly common on MRIs.  That's not to say that SLAP tears are not a possible source of pain in patients older than in their 20s, but it is important to combine information from your history, examination, and response to less invasive treatments, before determining if the SLAP tear seen on MRI is the source of your pain.

Bottom Line:

The take home message is not that all SLAP tears should be ignored, and not all SLAP tears need surgery (or any treatment).  It is just important to remember that reading "SLAP tear" on an MRI report may not mean much of anything.  It is just one piece of information that must be put into context of your history, your examination, and other information.  A skilled shoulder specialist should be able to help guide you on what treatment they feel is most effective for your shoulder condition.

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