• Diagnosis
  • Treatment
  • Rehabilitation

Shoulder Instability and SLAP Tears

Also known as: Shoulder dislocation, Shoulder subluxation, Labral injury, Bankart Lesion, SLAP lesion

The shoulder is a ball and socket joint like the hip, but the cup that the ball sits in is very shallow so needs to be held in place by cartilage, ligaments and muscles. When these mechanisms fail through wear and tear or injury, the shoulder can become partly (shoulder subluxation) or totally dislocated (shoulder dislocation). There are different conditions according to which anatomical part is causing the problem.

Patients of all ages can suffer from shoulder instability but it is most commonly seen in young athletes particularly those who take part in collision sports such as rugby. They often sustain injuries to the cartilage (labrum) around the joint (labral injury or Bankart lesion).

SLAP tears or lesions are where the injury occurs at the point where the tendon of the bicep muscle joins the labrum. They can be caused by falling onto an outstretched hand, repetitive overhead activities like throwing or lifting heavy objects.

Patients who have suffered a previous shoulder dislocation are also more prone to shoulder instability.

Symptoms

Patients with shoulder instability are often troubled by the sensation that their shoulder is about to come out of place.

Symptoms of shoulder dislocation in a younger patient (under 40) are often persisting tissue weakness and tendency to re-dislocate.

SLAP lesions can occasionally cause pain, weakness, difficulty with overhead activities such as throwing and a popping sensation.

Investigation

X-ray, MRI scan, and sometimes a CT scan will help determine the nature of the injury.

Shoulder Instability and SLAP Tears

Patients with laxity (looseness) of the joint require a programme of physiotherapy to strengthen the muscles and structures around the joint.

For a structural tear of the labrum, surgery is normally required to repair it. Surgery can often be keyhole but occasionally the injury is severe enough to require open surgery. A general anaesthetic is mostly preferred. During surgery the torn labrum is fixed back to the bone with sutures (stitches) and bone anchors.

Shoulder Instability and SLAP Tears

The shoulder muscles are strengthened very gradually while allowing the operated tissues to recover. Gentle strengthening exercises to the shoulder muscles, postural realignment to the shoulder blade and then range of movement exercises to stretch the shoulder are introduced over a six week program.

Shoulder instability operations need to avoid certain shoulder movements in the early stage in order to ensure that the repaired tissues are not stretched. After six weeks these restricted movements will gradually be introduced to ensure full movement of the shoulder is restored.