A Sports Medicine Moment

Spring means baseball. Most athletes remain active year-round, cross training with other sporting activities. Some will find that resuming an overhead sporting activity such as throwing may be associated with shoulder pain. One of the possible causes of pain or discomfort might be a SLAP (superior labrum from anterior to posterior) tear within the shoulder's ball-and-socket joint. This is an injury within the shoulder joint where the tendon of the long head of the bicep muscle inserts onto the labrum at the top of the socket. What Causes a SLAP Injury This problem can be associated with repetitive overhead activity such as throwing, a traumatic tear from a fall or any forceful pull on the upper extremity. This problem may be misinterpreted as a shoulder strain by the athlete as it could have been acquired during a fall in the offseason, only later diagnosed when a high volume of overhead activity is resumed at the start of the season. Symptoms Pain is usually experienced during throwing activity or with any position of the arm causing a pull on the bicep tendon. Discomfort may radiate from the back to the front of the shoulder or may be isolated. Rest relieves the discomfort until activity is resumed. Diagnosis An experienced examiner can test the shoulder and narrow the problem down to the labrum or bicep. The athlete's description as to when the pain occurs and what motion causes discomfort helps. A Contrast MRI (magnetic resonance imaging) can help confirm a SLAP tear and may show other shoulder pathology such as rotator cuff problems. Treatment Some SLAP problems respond to rest, non-steroidal medication or activity modification. A high-demand thrower may require arthroscopic treatment for debridement or repair to put the labrum back to the socket. Rehabilitation Physical therapy helps the athlete maintain range of motion in the shoulder, progressing to strengthening and eventually high-velocity pitching three to five months after an arthroscopic repair. Actual returns vary depending on each athlete and sport. -