So how do we get SLAP tears? One mechanism is falling onto our shoulders, another is traction that we talked about earlier and another is repetitive stress. People will complain of clicking in that shoulder that they do not have in the other shoulder. Others will feel like something is moving around in their shoulder. They will typically point to the front and top of their shoulder right at the AC joint or sometimes even the back upper half of their shoulder. Sleeping can be painful as the labrum can get pinched as the humerus rolls into it with compression. Reaching out away from their body and picking up a heavy bag can also be painful.
Diagnosing can be done with a physical exam as there are a multitude of tests that are described to determine if one has a tear. Sometimes an MRI with contrast is recommended to see if there is a tear. As you can see below fluid which is white travels underneath the black triangle at the top of the cup or glenoid and illustrates the tear.
Now that we know people have tears, what can be done? There is rehab to try to strengthen the muscles around the shoulder. Sometimes this works and sometimes it does not. If the pain persists and people are having trouble with activities of daily living or sports, then we can fix the problem. You can see the sutures that are tied around the labrum holding it into place in the picture below. The bone will then grow into the labrum and reestablish the connection between the biceps labral complex and the glenoid. Rehab from this can be 4 months for normal activities and 6-9 months for aggressive lifting, throwing or pull-ups. Initially the arm is moved passively by the therapists to maintain motion without stretching. Then once the labrum is partially healed to the bone active motion can be initiated. You can see the protocol for rehab at my site www.orthopedicsne.com.
As I mentioned in an earlier post and you may be asking, “what if I don’t have a SLAP and don’t want to get one?”
Well sometimes people with that type of external rotation have what is called internal rotation contractures where their shoulders have adapted and become stretched out in the front half and very tight in the back half of their shoulder joint. When this happens you lose internal rotation because the ligaments in the capsule are tight and don’t allow you to move your arm in that direction as seen here.
So you can imagine if the back half of the shoulder is rigid and not loose, the ball of the socket will get pushed forward when you are doing a kipping pullup. And this finally brings us to prevention. If you can loosen up the back half of your shoulder joint then the ball will not get pushed forward, during pull-ups or any overhead activity like snatches and overhead squats. Stretching the back half of the shoulder can be accomplished in a few ways- here is a great shot of a few exercises.
We can see the cross body stretch and in the lower left the sleeper stretch. Other great forms of stretching are with elastic bands and lacrosse or baseballs put right in the back of the shoulder and rolling out the muscles in the back of the shoulder. The other way that we can be smarter about our shoulders is keeping our pull-up form tight and not throwing our body forward violently on the kip. This will keep the shoulder from rotating too far into external rotation and keep a more neutral position on the ligaments on the front of our shoulders. In order to do this the legs also have to be in control and not flailing too far forward or backward on the swing. Legs need to be underneath and slightly extended at hips as opposed to the heels hitting the back and arching as seen with out of control kips.
As Isaac Newton said, “If I have seen further, it is by standing on the shoulders of giants.” He was saying he learned because of the people who came before him helped him see and taught him more. I hope the CrossFit community can learn from the past, improve our mobility and decrease any injuries by adopting new techniques and protect the giants’ shoulders.