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Sports Medicine | Apr 24, 2019

One of the most feared conditions when it comes to baseball players’ ability to remain competitive is a SLAP (Superior Labrum Anterior to Posterior) tear. While in the ‘70s the injury best known for taking out players in their prime was a UCL tear in the elbow, the development of “Tommy John” surgery was able to return many players to the field in as good as condition as before. Not so with a SLAP tear, which often signals the end of a pitching career.

What is a SLAP Tear?

The shoulder is a ball-and-socket joint made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The head of the humerus fits into a rounded socket in the scapula called the glenoid.

Around the outside edge of the glenoid socket is a thick rim of strong tissue called the labrum. The labrum is important, because it not only deepens the socket and makes shoulder dislocation less likely, but it also serves as an anchor for the many ligaments radiating from the shoulder and for one of the tendons from the arm’s bicep muscles.

This strong connective tissue is typically able to withstand most range of movement, but in a sport like baseball, a pitcher’s throwing arm undergoes a series of motions which can cause a tear either in the front (anterior) or the back (posterior) of this attachment point.

What are the Symptoms of a SLAP Tear?

Typical symptoms of a torn labrum are a catching or locking sensation when the arm is rotated through the shoulder socket. There may also be pain with certain shoulder movements, often occurring deep within the shoulder or with certain arm positions.

How can SLAP Tears be Prevented?

Pitching consists of five phases: the wind-up, early cocking, late cocking, acceleration, and follow-through. Two phases present the most risk to the pitcher.

  • Late cocking: For maximum pitch speed, the pitcher rotates the arm and hand up and behind the body creating a position of extreme external rotation. This increases ball speed, but also forces the head of the humerus forward which stresses the labrum and ligaments front of the shoulder, loosening them – which allows more rotation, but destabilizes the shoulder over time.
  • Follow-through: The arm rapidly rotates internally during acceleration, but once the ball is released and follow-through begins, the ligaments and rotator cuff tendons attached to the labrum at the back of the shoulder endure significant stress as they provide the stopping power to decelerate the arm motion.

Pitch analysis and extra training can help athletes control their arm movements during late coking and follow-through phases of their pitch to minimize damage and risk while still providing a high level of accuracy and speed.

SLAP Tear Treatment

Arthroscopic surgery is most often recommended for SLAP tears to repair the labrum. After the surgery, a careful recovery and rehabilitation plan is laid out, which may take up to a year to complete. While formerly most players with a SLAP tear were unable to return to former levels of competitive play, several high profile players have found success with labrum surgery, coming back stronger than ever.

Notable among these players is Trevor Hoffman, who played 18 years in the MLB, including a 15 stretch as a closer for the Padres. He had rotator cuff and labrum surgery, switched his pitching style, and ended up being one of baseball’s most effective pitchers. Ironically, he didn’t originally hurt his shoulder pitching, but with another overhead shoulder rotating move – playing beach volleyball.  

If you have intermittent but deep seated shoulder pain or feel your shoulder joint catching as it rotates, contact Strasburger Orthopaedics for a consultation. Dr. Strasburger has a full range of arthroscopic surgical procedures and complementary therapies to help relieve pain and restore range of motion.