Giovanna Florencia Padilla, PT, DPT
Your shoulder is a ball and socket joint, which allows for maximal mobility for things like scratching that pesky spot between your shoulder blades, screwing in a lightbulb overhead, pitching a ball, and, for our Seattleites, necessary for throwing fish at the Pike Place Market with top speed and accuracy. The shoulder depends on both active structures, like your rotator cuff muscles and muscles of your shoulder blade, as well as more passive structures like the glenoid labrum and shoulder ligaments, to provide it with stability through these large ranges of motion.
One common injury to the shoulder is called a SLAP tear. This is an injury to the glenoid labrum, which is the ring of fibrocartilage around the socket in your shoulder whose job it is to increase stability of the shoulder by creating a better fit for the ball and socket joint. SLAP stands for Superior Labrum Anterior Posterior. In other words, there is a tear on the top of the labrum that extends from the front to the back side of the tissue. One commonly affected secondary structure in a SLAP lesion is the long head of the biceps tendon, which attaches at the top of the labrum.
The risk factors for a SLAP lesion include the following:
- Repetitive shoulder movements can cause microtrauma to the shoulder that can progress in damage with time. This happens in particular with throwing athletes (or fishmongers) and workers who use their shoulders especially for repeated overhead reaching motions.
- Above the age of 30. Research has shown that the labrum weakens as we get older.5 While this is a normal age related change, it highlights the importance of continuing with strength training, so less stress is placed on the passive structures of our shoulder, like the labrum.
- Direct Trauma. Examples of this include car accidents, falling on an outstretched arm, or injury from heavy lifting.
What do the experts say?
Dr. Jonathan Hodax, MD, MS of Virginia Mason Orthopedics, shared with us that one of the best warning signs amongst his patients with a SLAP lesion are a vague shoulder pain, worse with overhead motion, and often radiating to the front of the arm along their bicep.
His patients with a SLAP tear primarily fit into 3 categories:
- Younger overhead athletes (throwers, swimmers, and volleyball players)
- Older patients with degenerative tears more associated with biceps tendinopathy
- Patients over 40 have some mild breakdown of the superior labrum on imaging, which is normal degenerative change.
Non-surgical candidates of Dr. Hodak’s are referred to PT for stabilization training. At Avant, we will focus on strengthening and coordination of the rotator cuff, addressing capsular tightness or asymmetry in shoulder motion, stabilization training, and correcting any errors in throwing form. In addition, we will focus on functional training that meets each patient’s needs including throwing, deceleration exercises, plyometrics, and replication of work specific tasks. The goal at discharge is to ensure that the affected shoulder is ready to meet all demands required of it.
Reach out to schedule an appointment if you have concerns about shoulder pain, instability, or lack of speed or accuracy in your throwing (talking to you fishmongers too!)
“The busy season for us is definitely Christmas time. We are constantly filling boxes with fish to send out, and throwing fish back and forth to each other when we have a live audience. I started feeling an increase of pain when throwing the fish and felt like I couldn’t throw as far.”
-Fish monger at Pike Place Market
POWELL S.E. et al., The Diagnosis, Classification, and Treatment of SLAP Lesions. Oper Tech Sports Med, 2012;20 (1):46 – 56
KOZIAK A. et al, Magnetic resonance arthrography assessment of the superior labrum using the BLC system: age-related changes mimicking SLAP-2 lesions. Skeletal Radiology, 2014;43: 1065 – 1070
WILK K.E. et al, The recognition and treatment of superior labral (SLAP) lesions in the overhead athlete. Int. J. Sports Phys. Ther., 2013; 8(5): 579-600
Nytimes.com. 2021. For a Perfect Catch in Seattle, Fishmongers Go for the Halibut (Published 2016). [online] Available at: <https://www.nytimes.com/2016/08/29/us/catching-fish-at-seattle-pike-place-market.html> [Accessed 29 October 2021].