By Dr. Eric W. Edmonds
Previously in Playing Safe, we have discussed various forms of injury to the shoulder in children. Many are caused by overhead sports participation, but others are traumatic. Injury to the labrum (the shoulder gasket that keeps the arm bone centered on the shoulder blade) at the very top (or superior aspect) can be created by a combination of both trauma and overuse.
The labrum is notorious for being injured during a shoulder dislocation.
Overhead activities can put strain on the superior aspect of the joint. Usually related to a phenomenon called internal impingement, this problem occurs primarily in baseball, softball, water polo, swimming, tennis, volleyball and gymnastics.
When the young athlete brings the arm back into the cocked position, it can cause the superior labrum to get pinched between the arm bone and the shoulder blade. Or, perhaps, the motion of rapidly rocking the shoulder back and forth (as seen when throwing or striking a ball) creates an excessive pull on the biceps tendon which is attached to the superior labrum. In either scenario the labrum can become torn and detached from the shoulder blade side of the joint.
When this tearing occurs in the superior aspect and both in front and behind the biceps tendon, then we call it a superior labrum anterior posterior tear, or SLAP tear.
SLAP tears occur in the normal population at a rate of about 30 percent. Meaning, if we looked in the shoulders of adults aged 30 to 50, with no complaints of pain, we would find evidence of SLAP tears. This implies that people can tolerate these injuries. The real issue is whether or not athletes can tolerate these tears. Although some can, many cannot even after surgery to repair the tear.
The best option for the treatment of a SLAP tear is prevention. As there may be an association with poor mechanics, overhead athletes should maintain a stretching program to maintain overall internal rotation of the shoulder. Moreover, they should perform a rotator cuff and shoulder blade stabilizing muscle-strengthening program. This can be done at home, but perhaps is better done as a team — so that everyone can work to prevent shoulder injury.
If your son or daughter has already been diagnosed with a SLAP tear, then initial treatment is physical therapy. Similar to prevention, improving the shoulder mechanics will often resolve the pain and allow the athlete to get back to overhead sports. If they should fail to improve with conservative management, then surgery may be necessary.
Contact your doctor if your child has shoulder pain that does not improve after two weeks of rest, or if the pain is associated with a fever.
Dr. Eric W. Edmonds is a pediatric and adolescent orthopedic sports medicine specialist at Rady Children’s Hospital-San Diego and an assistant professor of orthopedics at UC San Diego. He can be reached at sports@rchsd.org.