Chiropractic Treatment of SLAP Lesions
The significance of a confirmed labral tear is debatable since this finding is present in more than half of asymptomatic middle-aged patients. (1) However, in the presence of any joint pathology, patients will often develop compensatory movement patterns in everyday life and athletic activity or sacrifice one injured tissue for another until performance decreases or pain increases to an unacceptable level.
Chiropractors must understand how to manage patients with SLAP lesions, as the impact of a confirmed labral tear cannot be understated. Some patients may need surgery, while others would benefit significantly from conservative measures only. The joint function and goals of the patient often direct the need for a surgical consultation instead of the structural deficit.
Overhead athletes, more specifically baseball players, are one of the most studied shoulder pain populations due to their high incidence of SLAP lesions and rotator cuff pathology. Current standards of care place little support on surgically repairing a structural lesion visualized on MRI. New studies have highlighted the importance of correcting the underlying functional movement restrictions instead of simply managing the tissue source of pain. Chiropractic management of shoulder injuries is becoming more popular as many athletes see the benefit of conservative treatment. Compared to surgical repair, conservative management yields similar or superior results in return to past performance (RPP) and return to play (RTP). (2)
What is a SLAP Lesion?
The acronym “SLAP” stands for Superior Labrum Anterior Posterior and is used to describe a tear or detachment of the shoulder’s superior glenoid labrum, originating at the anchor site for the long head of the biceps tendon and extending into anterior or posterior portions of the labrum. (3) This pathology is relatively common, as 25% of patients undergoing shoulder arthroscopy for any diagnosis will demonstrate a SLAP lesion. (4,5)
Can a chiropractor treat a SLAP lesion?
The presence of a SLAP lesion does not automatically necessitate surgical intervention. Most clinicians view this structural abnormality with the same skepticism as “disc lesion,” “meniscus tear,” or “rotator cuff tear”- wherein the imaged defect is not necessarily the primary contributor to the patient’s complaint. Most experts, including the American Academy of Orthopedic Surgeons, recommend a 6-12 week course of conservative management before considering surgical intervention. (6-8)
How do chiropractors treat SLAP lesions?
Non-surgical treatment correcting scapular dyskinesis and GIRD has a reasonable success rate in MLB players with a documented SLAP lesion. (2) Conservative treatment goals include pain reduction, enhancing mobility, and restoration of strength. (7)
Specific treatment strategies should include:
Restoring Glenohumeral Joint Mobility
Strengthening of the Scapular Stabilizers
Increasing Glenohumeral Internal Rotation
Improving Core Stability
Overhead-throwing athletes often demonstrate a deficit in glenohumeral internal rotation. Manipulation and soft tissue techniques directed to the shoulder can significantly and quickly increase shoulder internal rotation. (13,14)
When should I refer a patient to surgery?
There are no universally agreed-upon indications for surgical SLAP repair. However, consider an immediate surgical consultation in cases of suprascapular nerve compression from an associated paralabral cyst. (10) Also, there is evidence to support surgically repairing type 2 SLAP lesions with co-existent rotator cuff tears in older patients (greater than 50). (10)
How long is the post-op recovery after a SLAP surgery?
Only 7-57% of elite overhead athletes can return to the pre-injury level of competition following surgical SLAP repair. (11,12) The co-existence of partial-thickness rotator cuff tears often correlates with the inability to return to the pre-surgery level of competition. (12)
What can you do for patients who have already undergone surgery?
First, prevent reinjury by avoiding detrimental compensatory patterns post-surgery. Patients with SLAP repairs have characteristic movement flaws during overhead throwing that limit their postsurgical performance.
Decreased shoulder horizontal abduction
Reduced shoulder external rotation
Excessive forward trunk tilt
These protective mechanisms may result in future shoulder pain due to improper loading of the glenohumeral joint. The study suggests that primary rehab strategies to facilitate standard pitching mechanics should include improving external shoulder rotation and horizontal abduction at 90°. (9)
Secondly, the mechanics that caused the problem should be corrected. A Sports Health (2023) paper found that pitchers should consider decreasing maximum shoulder adduction angles at later pitch stages.
During throwing, increased horizontal arm adduction places more stress on the shoulder complex and decreases ball velocity. While most athletes may throw caution to the wind when it comes to injuring their bodies, they will always make changes to improve performance! So, coach your next postsurgical patient to consider utilizing less horizontal adduction in their follow-through. (15)
As chiropractors, it’s easy to question our decisions and constantly wonder whether we might be missing something or if there’s room for improvement. After all, new research emerges every week, and it’s up to us to adapt accordingly to ensure our patients receive the best care possible. Say goodbye to doubt and hello to confidence with ChiroUp. Our comprehensive platform is designed to empower chiropractors like you to practice with assurance and precision.
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1. Schwartzberg R, Reuss BL, Burkhart BG et al. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Journal of Sports Medicine. January 2016 vol. 4 no. 1
2. Fedoriw WW, et al. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014. May;42(5):1155-60. Epub 2014 Mar 27.
3. Knesek M, Skendzel JG, Dines JS, et al. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med 2013;41(2): 444–60.
4. Kim TK, Queale WS, Cosgarea AJ, McFarland EG. Clinical features of the different SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am. 2003 Jan. 85-A(1):66-71.
5. Kampa RJ, Clasper J. Incidence of SLAP lesions in a military population. J R Army Med Corps. 2005 Sep. 151(3):171-5.
6. Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: pathoanatomy and surgical management. J Am Acad Orthop Surg. 1998 Mar-Apr. 6(2):121-31
7. Dodson CC, Altchek DW. SLAP Lesions: An Update on Recognition and Treatment. JOSPT February 2009, Volume 39 Number 2
8. Franceschi F, Longo UG, Ruzzini L, et al. No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50: a randomized controlled trial. Am J Sports Med 2008;36(2):247–53.
9. Laughlin WA, et al. Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair. Am J Sports Med. 2014. Dec;42(12):2837-41.
10. Franceschi F, Longo UG, Ruzzini L, et al. No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50: a randomized controlled trial. Am J Sports Med 2008;36(2):247–53.
11. Laughlin WA, et al. Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair. Am J Sports Med. 2014. Dec;42(12):2837-41.
12. Neri BR, et al. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears. Am J Sports Med. 2011 Jan;39(1):114-20. Epub 2010 Oct 12.
13. Ohuchi K, Kijima H, Saito H, Sugimura Y, Yoshikawa T, Miyakoshi N. Risk Factors for Glenohumeral Internal Rotation Deficit in Adolescent Athletes: A Comparison of Overhead Sports and Non-overhead Sports. Cureus. 2023 Jan 21;15(1). Link
14. Jácome-López R, Tejada-Gallego J, Silberberg JM, García-Sanz F, San José FG. Treatment of glenohumeral internal rotation deficit in the general population with shoulder pain: An open single-arm clinical trial. Medicine. 2023 Sep 22;102(38):e35263. Link
15. Manzi JE, Dowling B, Trauger N, Hansen BR, Quan T, Dennis E, Fu MC, Dines JS. The relationship between maximum shoulder horizontal abduction and adduction on peak shoulder kinetics in professional pitchers. Sports health. 2023 Jul;15(4):592-8. Link
