SLAP injuries in baseball

Overhead athletes place a lot of stress on their shoulders that can lead to tissue injury over time. One of the injuries that occurs is a SLAP lesion, or a tear of the cartilage (labrum) in the shoulder. This injury can be painful and debilitating. For athletes that require their shoulder to perform their sport it is important to know how to treat these injuries.

Treatment for a SLAP lesion is either conservative physical therapy to reduce inflammation and improve shoulder movement and stability or surgery to clean the labrum up and potentially involve more in depth anchoring. Either method can lead to a return to play, but the question remains which is more effective and which leads athletes to return to their prior performance? Athletes don’t just want to return, they need to return at or above their pre injured state. Using performance markers to gauge success sheds light on the best treatment options.

As with most things in medicine and injuries, the answer is not straight forward. Professional baseball pitchers who sustain SLAP tears do not return to the prior performance as well as position players do. The extra strain on the shoulder every pitch may be too much to handle regardless of the treatment tried. Athletes that have a rotator cuff tear in addition to a SLAP lesion have even worse outcomes; they tend not to return at all. Debriding the labrum is less invasive so athletes tolerate this procedure better than more in depth surgical intervention when returning to their sport. The good news is that athletes who underwent more physical therapy had similar return to play and return to prior performance as their surgical counterparts.

When treating overhead athletes efforts can be made to rehab them as long as possible in hopes of prolonging their playing days. Surgery is not a guarantee of continued play, so rushing into surgery hoping to improve your sport may not occur. Like other conservative therapy of the shoulder, the goal is to reduce pain and improve movement and stability. Focusing efforts in correcting GIRD, addressing posterior capsule tightness and improving scapular stability when treating baseball players with SLAP lesions can help keep them playing.

Fedoriw, W. et. al. (2014). Return to play after treatment of superior labral tears in professional baseball players. AJSM (42); 1155. http://ajs.sagepub.com/content/42/5/1155