The MRI results are in and you see results that have you questioning if you can ever throw a baseball, hit a volleyball, or skip a rock ever again. The last thing anyone ever wants to hear is that a piece of their anatomy is torn or degenerated and that surgery may be required. Sometimes surgery is necessary and success rates for the general population and most athletes are typically high. Throwing athletes can be an exeption. Visiting a chiropractor to discuss what treatment options may be right for you can go a long way to prevent recurring issues and could potentially prevent surgery. The following is some important information that you need to know about what a SLAP tear actually is and what outcomes can look like post-surgery.
The glenohumeral (shoulder) joint is a shallow ball and socket in which the head of the humerus (ball) articulates with the glenoid fossa (socket) of the shoulder blade. Very little surface area exists between the two bones. This type of joint allows for a large range of motion and is inherently the least stable joint in the body.
When a pitcher maximally rotates him arm back (external rotation) in the late cocking/early acceleration phases of throwing, tension pulls the attachment of the long head of the biceps brachii posteriorly on the labrum and results in micro-tearing of the glenoid labrum. Over time, due to the repetitive nature and shear violent mechanics involved with pitching, the labrum undergoes changes and can result in 4 grades of labrum "tears or abnormalities." However, some of these may not even be abnormal but actually functional adaptations of the joint to allow for greater external rotation at the shoulder so that athletes can throw at higher speeds and for longer distances.
Furthermore, some of these tears may actually be acute traumatic tears where a large portion of the tear occurs at once. How the tear occurs can have a significant effect on how the shoulder responds to injury. Tearing may show no effect or may present with pain or altered performance.
If you're been a throwing athlete for an extended period of time, chances are that you have one or more of the following: labrum abnormalities, partial thickness rotator cuff tears, SLAP lesions, or Bankart lesion lesions. Interestingly, many of these are asymptomatic and have little to no effect on the throwing athlete.
From the time you throw your first baseball as a child until the day you throw your last pitch, your arm is constantly changing and adapting. If you place a throwing athlete next to a someone of that has never played an overhead sport before, you will notice significant differences.
The fact of the matter is that your arm is constantly changing to adapt to specific functions. For an athlete to gain the external rotation necessary to throw 90+ mph the anatomy has to deviate from the norm. Micro-trauma and subsequent repair of soft tissues such as the labrum and tendons allows the shoulder to maximize its force-transfer efficiency to deliver stronger throws.
Surgery for SLAP repair in the general population generally has high success rates. For the athlete with a goal of returning to sport, these rates are significantly lower. These rates continue to decrease if the athlete hopes to return to the same levels of performance.
Sometimes an MRI finding is just that. A finding. In fact, some might argue that labrum abnormalities are functional adaptations that allow for greater external rotation of the shoulder to increase velocity and force transfer. Whether or not these findings are a pain generator or are effecting performance should be evaluated by licensed professional. Chiropractors and physical therapists are two great places to start the recovery process.