Labrum Tear Treatments

Initial treatment of superior labrum anterior and posterior (SLAP) tears includes non-surgical methods that alleviate pain and regain optimal shoulder function.¹Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;2003(1):CD004016. doi:10.1002/14651858.CD004016

The objective is to relieve discomfort, improve mobility, and enhance the stability of the shoulder joint.

Pain-Relieving Medication

Over-the-counter medications, including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen, are typically used for alleviating pain associated with labral tears.²Tauberg B, Denehy K, Prodromo J, Kumar NS, Mulcahey MK. Nonoperative Management of Common Shoulder Conditions.

If over-the-counter medications fail to relieve pain, prescription medications, such as tramadol, are recommended.³Garbis N, Romeo AA, Van Thiel G, Ghodadra N, Provencher MT, Cole BJ, Verma N. Clinical indications and techniques for the use of platelet-rich plasma in the shoulder. Operative Techniques in Sports Medicine. 2011 Sep 1;19(3):165-9. doi:10.1053/j.otsm.2011.03.002

Physical Therapy

One of the mainstays of the treatment of SLAP tears is physical therapy.⁴LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS. 2021;6(4):204-211. doi:10.1136/jisakos-2020-000537

The goals of physical therapy for SLAP tear injuries include⁴LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS. 2021;6(4):204-211. doi:10.1136/jisakos-2020-000537:

• Improving strength and mobility of the rotator cuff, chest, and shoulder blade muscles 
• Ensuring smooth movement of the shoulder blade and the ball and socket shoulder joint

If engaging in physical therapy is too painful, doctors recommend corticosteroid injections into the shoulder joint to reduce pain and inflammation before commencing the exercise program.⁴LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS. 2021;6(4):204-211. doi:10.1136/jisakos-2020-000537

Studies suggest that physical therapy is as effective as surgical procedures in the management of SLAP tears, especially in recreational athletes.⁵Shin SJ, Lee J, Jeon YS, Ko YW, Kim RG. Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3296-3302. doi:10.1007/s00167-016-4226-7

Home Remedies 

Natural therapies complement physical therapy and accelerate the healing of the labrum cartilage. These remedies include¹Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;2003(1):CD004016. doi:10.1002/14651858.CD004016:

• Resting and avoiding overhead activities prevents aggravating the injury
• Immobilizing the shoulder using a sling or brace to limit motion in the injured arm reduces pain and facilitates faster healing
• Modifying daily activities to reduce stress on the affected shoulder, such as avoiding lifting heavy objects or modifying the workstation, prevents exacerbation of the injury
• Applying ice packs to the shoulder for 15-20 minutes 2-3 times per day to reduce pain and swelling

Additionally, obtaining adequate sleep, consuming a balanced diet, and staying hydrated support the overall healing of the shoulder’s soft tissues.

Injection Treatments 

While not a definitive cure, injections offer a minimally invasive approach to alleviate SLAP tear pain and potentially promote labral healing.⁴LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS. 2021;6(4):204-211. doi:10.1136/jisakos-2020-000537Injections provide an alternative for individuals who prefer to avoid surgery.⁵Shin SJ, Lee J, Jeon YS, Ko YW, Kim RG. Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3296-3302. doi:10.1007/s00167-016-4226-7

Injections for SLAP tears work in one of two ways: 

• Relieve inflammation and pain
• Promote healing through the regeneration of tissues

Most patients receive a series of injections over a specific period of time.

Steroid injections

A mixture of anesthetic medication (such as lidocaine) and steroids are injected into the shoulder joint.

A study involving 46 middle-aged patients with SLAP tears, all of whom received a corticosteroid injection in the shoulder joint in conjunction with physical therapy, found ⁵Shin SJ, Lee J, Jeon YS, Ko YW, Kim RG. Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3296-3302. doi:10.1007/s00167-016-4226-7:

• All patients showed an improvement in pain during the initial 2 months
• Around 26% of patients showed recurrence of pain after 2.4 months, with about 40% showing improvement with a second corticosteroid injection

If the pain returns, a follow-up injection is sometimes prescribed after a few months.⁵Shin SJ, Lee J, Jeon YS, Ko YW, Kim RG. Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3296-3302. doi:10.1007/s00167-016-4226-7  

Potential risks associated with steroid injections include¹Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. 2003;2003(1):CD004016. doi:10.1002/14651858.CD004016^,6Park SK, Choi YS, Kim HJ. Hypopigmentation and subcutaneous fat, muscle atrophy after local corticosteroid injection. Korean J Anesthesiol. 2013;65(6 Suppl):S59-S61. doi:10.4097/kjae.2013.65.6S.S59^,7Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis. 2009;68(12):1843-1849. doi:10.1136/ard.2008.099572:

• Temporary increase in pain
• Transient increase in blood glucose levels
• Increased risk of infection
• Headache
• Tendon rupture

Corticosteroid injections also have the potential to cause permanent skin atrophy (wrinkling or thinning of skin) or depigmentation in some individuals.⁷Gaujoux-Viala C, Dougados M, Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis. 2009;68(12):1843-1849. doi:10.1136/ard.2008.099572

Platelet-rich plasma (PRP) therapy 

Blood plasma enriched in platelets (a type of blood cell) contains a high concentration of growth factors to potentially stimulate the healing of degenerated labral tissue.³Garbis N, Romeo AA, Van Thiel G, Ghodadra N, Provencher MT, Cole BJ, Verma N. Clinical indications and techniques for the use of platelet-rich plasma in the shoulder. Operative Techniques in Sports Medicine. 2011 Sep 1;19(3):165-9. doi:10.1053/j.otsm.2011.03.002^,8Vander Kraats R, Doss A. Glenoid labral tear: follow up case series on ultrasound guided autologous platelet rich plasma in conjunction with a progressive rehabilitation program. F1000Research. 2012 Dec 19;1:68. https://doi.org/10.12688/f1000research.1-68.v1

PRP therapy involves injecting the patient’s own plasma enriched in platelets to accelerate the healing of musculoskeletal injuries, including injured tendons, joints, ligaments, and muscles.⁹Schneider A, Burr R, Garbis N, Salazar D. Platelet-rich plasma and the shoulder: clinical indications and outcomes. Curr Rev Musculoskelet Med. 2018;11(4):593-597. doi:10.1007/s12178-018-9517-9

Emerging evidence suggests that platelet-rich plasma therapy could be an effective option for SLAP tear injuries, but more research is needed to establish the efficacy of this treatment.

See Are PRP Injections Effective?

Surgery for SLAP tears involves removing or reattaching the damaged shoulder labrum, and/or reattaching the accompanying tear in the biceps tendon.