The shoulder is the most mobile but least stable joint in the body. Because it’s used repetitively by throwing athletes, special attention should be paid to maintaining its strength, health, and function. In order to prevent injuries, it’s important that athletes educate themselves. One of the most common injuries sustained by throwing athletes is a SLAP tear of the soft tissue, known as the labrum, that helps hold the shoulder in place.

Illustration 1- A SLAP tear

SLAP Tears

A SLAP (superior labrum anterior and posterior) tear is a serious injury that sidelines athletes for an extended period of time. In some cases, it can be treated with physical therapy. However, in most, it requires surgical intervention. Recovery is physical therapy intensive and can take 8-12 months.

Causes of a SLAP Tear

The injury usually occurs during the “early acceleration phase” of the throwing motion. With the arm in this position the biceps attached to the labrum twists and peels back the labrum from the socket.  Risks for this are increased with GIRD or glenohumeral internal rotation deficit.  This condition is thought to occur from repetitive microtrauma to the posterior capsule of the shoulder with thickening of the capsule and loss of shoulder internal rotation.  As the labrum tears there typically is a loud “pop” and the feeling of a dead arm.

Illustration 2- SLAP tears usually occur during the follow through (fourth picture) of the throwing motion

Signs and Symptoms of a Throwing Injury

The following signs might be indicative of a SLAP tear:

• Locking, catching, popping, and/or grinding of the shoulder
• Inability to effectively throw
• Decreased range of motion

Common symptoms include:

• Pain
• Severe weakness
• Joint laxity

Swelling and numbness can also occur.

Diagnosis of a Throwing Injury

Orthopedic surgeons are the most qualified medical professionals to diagnose SLAP tears. Many throwers with shoulder pain have GIRD and are at increased risk for suffering a SLAP tear.  Specific exercises and stretching can help decrease this risk.  The evaluation process usually includes:

1. Taking a detailed medical history. Determining how and why the injury occurred provides diagnostic clues.

2. Performing a thorough physical exam. Symptoms that present with certain movements or positions helps diagnose the injury. Assessing shoulder motion and shoulder blade function can help determine throwers at increased risk for SLAP tears.

3. Analyzing medical imaging studies. X-rays and MRIs help confirm the diagnosis.

Once a patient has been diagnosed with a SLAP tear, a treatment plan is made. 

Treatment for a Throwing Injury

As previously mentioned, SLAP tears are usually treated using surgical intervention. During the arthroscopic procedure, the specialist locates the tear and then repairs it using sutures anchors that reattach the labrum to the bone. The procedure usually takes 1-2 hours and is done on an outpatient basis.  In older athletes or in recurrent tears better success has been seen with a biceps tenodesis where the biceps is released from the labrum and reattached at the humerus. 

Seeking Treatment for a Throwing Injury

Athletes should never play with a throwing injury. If your shoulder hurts or you can relate to the information in this post, please don’t hesitate to contact one our 5 Long Island offices to schedule an appointment with one of our specialists. We’ll get you back on the field ASAP.