Anterior Shoulder Pain

Anterior Shoulder Pain: SLAP vs LHB
So, you have shoulder pain. The question is, “Why?” and “What is the cause?” (who am I kidding, your physio has at least 100 more questions!) Here are two things to consider:

1. SLAP tear: an injury to a part of the shoulder joint called the labrum. SLAP is an acronym for “Superior Labral tear from Anterior to Posterior”. The shoulder joint is a ball and socket joint (similar to the hip joint), except the shoulder is much more shallow. The labrum is a circular rim of cartilage, forming a cup for the end of the humerus to move within. The SLAP tear occurs where the biceps tendon inserts on the labrum.
2. LHB tendon pathology: The Long Head of Biceps tendon is a structure commonly involved with painful shoulder conditions caused by acute trauma, degeneration, or overuse. There is a large correlation between LHB tendon lesions rotator cuff (RC) tears.

Symptoms:

It is important to discuss the history of your shoulder pain and symptoms in detail with your physiotherapist at Revive, who will determine the cause of your pain through a detailed physical examination. Here are a list of symptoms you may be experiencing.

SLAP
Pain deep in the joint,  hard to be specific

• Catching/clicking sensation and pain with shoulder movements
• Loss of power with overhead movements (ie throwing/serving)

LHB
Pain at the front of your shoulder

• Overhead throwing athletes, a snap/pop during follow through phase can indicate LHB or SLAP lesion
• Sensation of instability/popping/grinding
• The “Popeye” sign or a lump on the outside of the arm can be present
• If pain is diffuse/vague, often another condition is present

Causes:

SLAP

Fall onto outstretched hand, repetitive overhead actions (throwing), lifting a heavy object

LHB

Rarely seen in isolation, commonly caused by overuse activities, shoulder joint instability (RC tear of supraspinatus/subscapularis), tendon damage (inflammation/irritation/bursitis, due to RC not functioning correctly, leading to overload of the LHB tendon) or an acute trauma (contact sport injury, gym incident)

Diagnosis:

It is recommended that you consult your physiotherapist at Revive for an accurate diagnosis, who will perform a thorough examination and a combination of tests to detect SLAP or LHB injury. You may need imaging done, which will be recommended by your physiotherapist upon your examination.

SLAP
A combination of tests is most directed with diagnosis Imaging: MRA (magnetic resonance angiography) vs MRI (in the absence of arthroscopy, which remains the gold standard diagnosis)

LHB
Pain on palpation of the front of your shoulder A combination of tests most directed with diagnosis Imaging: X-ray to rule out degeneration, AC joint arthrosis or bony abnormalities; Ultrasound or MRI for more comprehensive imaging.

Treatment:

SLAP
Conservative management for a minimum of 3 months to reduce pain and regain strength of the shoulder. In patients who fail to recover there are surgical treatment options that can be considered.

LHB
Conservative management for a minimum of 6 weeks, includes elbow flexion + supination into exercises. Exercises may include:

• Thoracic mobility/rotation exercises if relevant, a lack of thoracic rotation can precede the onset of shoulder pain in particular positions
• Gluteal strengthening, if a loss of lower limb power is detected, which can lead to increased load on the shoulder and effect throwing performance
• Surgical management: This will depend on presentation, duration of symptoms, persistent pain, failure of conservative management, coexistence of RCT/LBP partial thickness tear
• Before considering surgery, it is recommended to consult your physiotherapist at Revive, who will assess whether you may benefit from a referral to an orthopaedic specialist.