Slap tear treatment without surgery | Comprehensive Prolotherapy

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C
New research explored the many surgical options in the treatment of SLAP lesions, however, while there are many options, unfortunately the success rates of these surgeries are being called into question.

SLAP stands for superior labrum anterior and posterior, meaning there’s a tear from front to back on the top of the glenoid labrum of the shoulder. The glenoid labrum is a fibrocartilagenous structure, like lips, in fact the the word labrum means “lips.” These lips/labrum forms a deep pocket that helps keep the humerus bone in the shoulder socket.

When you have a labral tear, generally there are clicking sounds and a sense of shoulder instability and loss of strength. In sports, like tennis and baseball for instance, your serve and your pitch may have lost a lot of steam. See our supporting article SLAP lesions in major league baseball pitchers. In that research we find doctors suggesting that nonsurgical treatment should be considered for professional baseball players with documented SLAP lesions, as it can lead to acceptable return-to-play and return-to-previous-performance rates.(1)

The SLAP surgical options examined

Research from New York University says:

In a combined study from University of Minnesota and German researchers, doctors found that if conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions could be achieved. However what was the measurement of success? If it was return to sport, or function in older patients, it was not that successful.

These doctors also looked at the problem of “normal variations and degenerative changes” in the SLAP complex that need to be distinguished from “true”SLAP lesions in order to improve results and avoid overtreatment.” Possibly avoid a surgery based on the wrong recommendation.[3

Non-surgical injection therapy for SLAP lesions

Surgery as diagnostic tool causes concern

In a recent review of SLAP lesion repair surgeries, one author, Stephen C. Weber, MD, noted the rise in both the number of repair surgeries and complications associated with them.This study looked at the American Board of Orthopedic Surgery database for SLAP lesion repairs.

The author expressed concern over the number of young orthopedic surgeons performing SLAP lesion repairs and also the number of middle-aged and elderly patients receiving them given the complications associated.

He concluded that there should be a greater focus on educating young orthopedic surgeons so that they can recognize and treat SLAP lesions appropriately with the hopes of decreasing the amount of surgical repairs performed.(4)

Four years later researchers suggests the best diagnostic tool is still surgery and doing some repair while you are in there.

“36.8% of these surgeries were considered a “failure” and 28% had to be redone”

“Arthroscopic revision type II SLAP repairs yield worse results than primary repairs as reported in the literature, with workers’ compensation patients and overhead athletes doing especially worse.”

The above recent study published in the American Journal of Sports Medicine analyzed the post-surgical outcomes of athletes with SLAP lesions (superior labrum anterior to posterior tears).[7

One hundred seventy nine military athletes were used in the study, all of which underwent surgery to fix an existing SLAP lesion. Out of all the operations, 36.8% of these surgeries were considered a “failure” and 28% had to be redone. That means that 66 individuals had a failed surgery and 51 had to go back into the operating room.

At two to five year follow-ups, a significant amount of these athletes still had decreased range of motion in the affected shoulder. Researchers concluded that an age greater than 36 years old was the factor that was associated with an increased chance of surgery failure. Other studies have shown similar statistics with many participants unable to ever return to their previous pre-surgery activity level.

Alternative to arthroscopic surgery for slap lesions of the shoulder

It’s interesting that we keep coming across research studies that show very few patients with long-term pain relief from joint surgery. It’s even more interesting that researchers are recommending a decrease in the number of joint surgeries performed.

Most joint surgeries can be avoided with Prolotherapy, and surgical SLAP lesion repair is no exception.

The typical program involves three to six visits receiving Prolotherapy for Shoulder Pain. In our experience, tissues such as a labrum can heal faster with Platelet Rich Plasma (PRP). PRP involves extracting platelets and growth factors from the patent’s blood and injecting those substances into and around the injured area to repair the structures of the joint.

In some cases, cellular Prolotherapy or Stem Cell Therapy may be more advantageous. This involves extracting cells from your blood, fat, or bone marrow and using them to help tissue proliferation in and around the joint.

The average “shoulder patient” in our office usually needs about four treatments to make a full recovery, although this number can range anywhere from two-10 depending on the severity of the case. Treatments are spaced about four to six weeks apart and patients are given specific rehab instructions to optimize healing.

If you have questions about slap lesions of the shoulder, get help and information from our Caring Medical staff

1 Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014 May;42(5):1155-60. [Google Scholar]

2 Mollon B, Mahure SA, Ensor KL, Zuckerman JD, Kwon YW, Rokito AS. Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair. Arthroscopy. 2016 Oct;32(10):1954-1962.e1.  [Google Scholar]

Brockmeyer M, Tompkins M, Kohn DM, Lorbach O. SLAP lesions: a treatment algorithm. Knee Surg Sports Traumatol Arthrosc. 2016 Jan 27. [Google Scholar]

4 Weber, SC, et al. Superior Labrum Anterior and Posterior Lesions of the Shoulder: Incidence Rates, Complications, and Outcomes as Reported by American Board of Orthopedic Surgery Part II Candidates. Am J Sports Med. 2012 May 24. [AAOS]

5 Saqib R, Harris J, Funk L. Comparison of magnetic resonance arthrography with arthroscopy for imaging of shoulder injuries: retrospective study. Ann R Coll Surg Engl. 2017 Apr;99(4):271-274. doi: 10.1308/rcsann.2016.0249.  [Google Scholar]

6. Yıldız F, Bilsel K, Pulatkan A, Uzer G, Aralaşmak A, Atay M. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg. 2017 Feb;137(2):241-247. [Google Scholar]

7. Park S, Glousman RE. Outcomes of revision arthroscopic type II superior labral anterior posterior repairs. The American journal of sports medicine. 2011 Jun;39(6):1290-4. [Google Scholar]


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