SLAP Tear Experiences

Dear Fellow Climbers,
For some time I have had a nagging pain in my left shoulder so I finally went to my doctor who ordered an MRI Arthrogram. I got the results a few days ago. It appears I have a SLAP tear in my left shoulder. I am scheduled to see a specialist in three weeks to discuss treatment options.
From the limited research I have done so far it appears that in the great majority of cases the preferred treatment option is arthroscopic surgery followed by months of rehabilitation and PT, with the patient able to return to full or near full activity in a year or so. Insurance, fear of surgery, etc., are not the issue. For me the issue is being unable to climb for potentially up to a year (yes, I know that is somewhat short term, selfish thinking).
So I am wondering if there are other climbers who sustained SLAP tears and who achieved either full or near full recovery without the need for surgery? It would be great to know if there is a combination of stretches and strengthening exercises, etc., which can achieve a positive result, since my hope is by doing so I could keep going. Winter is coming and my passion is ice climbing, so I am hoping to climb this winter and in combination with doing the above, make a slow, steady, and smart recovery.
Is there anyone who uses this forum who might have some experiences, advice, tips, etc., to share.

Much appreciated and cheers,
Bob Loomis, Spokane, Washington

Hi, Bob. I have a SLAP tear in my left shoulder. I was able to avoid surgery by going to PT for seven months! The entire time, I was under the supervision of an orthopaedic surgeon and the PT was sort of a pre-hab for in case I needed to go under the knife. Luckily at the end of seven months, he gave me a clean bill of health! It was a very slow process though - the exercises my PT had me do were very subtle and with little if no resistance/weight. It also seemed that using electric heat helped my shoulder heal quicker too (my PT didn't put me on the steamer till the last few weeks of my therapy).

Ask your doctor if he/she thinks that if you can do a long PT and see if it improves your pain and/or range of motion. Worst case, you'll have a good pre-hab for the surgery.

The only thing about this approach is that I have to make sure my antagonist muscles are constantly strong enough (the upper back and shoulder muscles), which is not a huge deal since climbing takes care of this pretty good. Some moves like an overhead gaston do piss my shoulder off though...

Bob,

A SLAP tear is what led me to pursue my Doctor of Physical Therapy degree, so I am kind of partial to the subject. I will tell you that I had my left SLAP tear repaired arthroscopically and went through 4 months of rehab under a physical therapist. I began climbing easy slabs at ~3 months. By 6 months, I was climbing at my former level and in 1-2 more months, I was climbing personal bests.

After becoming a physical therapist, I have learned that many people have completely asymptomatic and problem free SLAP tears and many more have symptoms that can be managed very well without surgery. Though imaging has not confirmed it, clinical tests have shown that I likely have a SLAP tear in my right shoulder. The worst problems I get is occasional 'clicking' feeling when reaching in awkward positions.

Try seeing a good physical therapist for this and give it at least 4-6 weeks. None of this stuff like ultrasound and/or electrical stimulation for half of your visit.

Erik

I had one two years ago and had a SLAP Repair. I did the injury in Feb and knew it was bad when I felt and heard the pop in my shoulder.

I rested it hoping it was nothing and didn't do much on it until the end of April when it was feeling better and I started light climbing.

I did a climbing trip and started on moderates just fine on day 1. After three routes, I decided to try a difficult route and I had sensations when I clipped the first bolt, light pain on the second bolt, severe pain on the fourth, and agony on the fifth and anchors.

I went in and had an MRI and was told that if I kept climbing, I would damage the shoulder to the point where I would never climb again. There were two tears in the labrum. My shoulder was still in agony and the pain never let up until I had my surgery, which was around the third weekend in May.

Sometime around October I started climbing again, in fact, by late Jan, I was climbing harder and better before the surgery. I took my physical therapy very seriously though. In fact, I had awesome physical therapists that were all athletes. I graduated just over four weeks ahead of most people.

When I returned to climbing, it really wasn't how hard of routes you could climb at the start, but how many minutes you could spend climbing. I started in the gym and only did 15 minutes of wall time a night for a while.

The hardest thing was showing restraint from climbing again and waiting until the shoulder was really ready. I really wanted to start climbing in late August because it felt strong and I had my full range of motion. My surgeon told me I could climb again but the physical therapist advised against it. I hadn't climbed since Feb, so another six or eight weeks wasn't going to hurt.

Today, I am just over two years post-op, surgery was in May of 2011 and the shoulder is fine. I do have to stay disciplined on my internal and external rotation. I add in ring rows, pushups, and elbow planks. Most of the exercises compliment climbing, so they aren't too bad to do. All in all, the surgery was a lot easier than I thought.

I used the down time to work on my cardio with a lot of hard long hikes and trail running. Before the surgery approaches used to kick my ass, now I kick theirs. My climbing partners hated me on approaches after that.

Too bad I broke my ankle last July and lost all of the cardio and climbing conditioning though. :)

Anything you want to know, please feel free to email me.

John...

I've rehabed surgical fixes on SLAP tears and also kept a few folks out of surgery, but ultimately the stability of the glenohumeral joint relies on an intact labrum under extreme loads... stuff like figure-4s or reaching overhead into a gaston or undercling positions.

Like Erik said, the one year mark is usually an easy conservative estimate of the time it will take for you to be able to push your shoulder to it's pre-injury limits with no problems. Most people are back doing some sort of climbing in 3-4 months but you'll spend a good 6-8 months doing base mileage and conditioning to rebuild the strength and endurance in the soft tissue structures.

My two cents would be: If you really want to push your personal limits and not have to deal with the ups and downs of re-injury. Do the surgery sooner than later and get it taken care of. You already know that the labrum is damaged and even if you do manage to strengthen the shoulder back up it will never tolerate the same training load as if it had been fixed.

Like I said that's just my opinion, I wish you a quick recovery whichever road you choose.

I waited ONE YEAR.... post knife, to resume climbing. My arthroscopic surgery, became more than some pin holes cause when he got in there it was much worse than the MRI showed.

I sort of stayed with slab climbing, mostly, for the next year cause it would hurt on steep ground.

After 2 years it was starting to feel STRONG and my climbing improved.....

At 2.5 years, I did a really hard mantle, with my bad shoulder and I had no pain after .... Healed I figured.

Now 3.5 years into it.... I never really try to boulder really hard cause that makes my shoulder feel like I pitched 9 innings... but if I warm up I can pull pretty hard without after pain...

But I dont think I will ever get it back to 100%

OH Yea.... I am 60, in my 40th season of climbing, so I take what I can get, and call it good.

Best of luck to you.... fun with PT.

Mine was a bit more serious, but this was my experience!
~grammy

AC joint Reconstruction

Dear Fellow Climbers,
Wow--thanks for the responses. They are really helpful. Some of you were able to make recovery without surgery, while some of you needed the surgery. At least I know it is possible to make recovery without the surgery, but I am pragmatic--if the specialist I meet with in a few weeks (reportedly he is the best in my region and has done thousands of shoulders) says surgery is recommended, then I will likely just get on with it, and look to 2014 as a year of PT and gradual recovery. I will just have to wait until I meet with him.
A couple of observations I can share. At first for months I basically just denied the pain. In hindsight that was a mistake as continuing to climb through the pain may have earned me some character merit badges but made the injury worse than it might have been had I acted right away. For a while when I raised my left arm over my head to make a move it felt--in addition to painful--like the muscles and joint were in cold molasses--basically stiff. Over the last few weeks doing my own research and adding some stretches into my regime which create space in the glenohumeral joint--I now have fairly fluid movement and greatly reduced pain. It is not zero but a big improvement. Basically in the last two weeks, three times a day I do some stretches which gently pull the humerus down and out a bit. If pain is my guide, then I am finally doing something right while I wait to see the specialist. I used to not get any clicking sounds, but now I do as a consequence of these stretches. I feel an almost instant sense of relief when I hear one of those clicks now--like the relief when flexing your neck and you hear the vertebrae cracking. The sense of relief in the shoulder seems real to me and not psychosomatic. I ice after the stretching session. After researching online I am incorporating several strengthening exercises, which seem to be standard for this type of injury. When I read the radiologist's notes carefully (got those yesterday), he says there is a small tear of the bicep tendon at the origin as well, but overall says it is a SLAP tear.
I used to do dips to strengthen my triceps. But now I have stopped those. They were creating pain and when I thought about it basically a dip pushes the humerus head up into the whole rotator cuff complex. It seems the opposite is what I am after--to create some space in there so the labrum is no longer being rubbed and thus torn each time I am reaching, pulling, abducting, extending my arm. I am 58, soon to turn 59, so age and a lifetime of climbing is adding up. Any other thoughts are very welcome.

Cheers,
Bob Loomis, Spokane, Washington

In my case, (definite bad impingement from a type 3 acromion but also a possible SLAP tear), my muscles all around the shoulder girdle tense up to the point of spasm; causing significant secondary pain. Thus, I have weekly visits with a massage therapist. It hurts like fucking hell at times, but after a month I am seeing results. That, a circuit of Therabands and a good icepack are keeping me off the table for now.

Dear Fellow Climbers,
It occurred to me last night that it might be helpful if I posted the radiologist's findings verbatim. If anyone has some helpful insights into what the findings really mean, or could mean, I would be really grateful, since only a portion of the findings are understandable to me. I know the people who are responding are climbers and not M.D.s, Radiologists, Orthopaedic Specialists, etc., so do not think I am holding anyone to that standard. But one thing I like about climbing, among many things, is the people--generally we are a positive community, so it is in that vein that I am grateful for any thoughtful insights.

Findings: "There are mild degenerative changes at the acromioclavicular joint with small marginal osteophytes and subchrondral cysts. There is a type 1 acromial arch. There is no extravasation of contrast from the glenohumeral joint into the subacromial subdeltoid bursa. The rotator cuff tendons have normal signal and appear intact. There is increased signal within the intraarticular portion of the long head of the biceps tendon at the biceps anchor compatible with partial tearing. The biceps tendon has normal signal and position within the intertubercular groove. There is an irregular cleft of contrast within the superior labrum extending posterior to the biceps anchor. The humeral head is in normal position within the glenoid fossa. There is a subcortical lesion in the posterolateral humeral head measuring 9 x 11 x 16 mm. This has high T2 signal with speckled central areas of dark signal suggestive of chondroid lesion such as enchondroma. Impression: 1. SLAP tear with tear extending into the base of the biceps attrachment on the labrum. 2. Mild acromioclavicular osteoarthritis."

I genuinely appreciate all the helpful comments posted thus far, and will continue to be grateful.

Cheers and safe climbing,
Bob Loomis, Spokane, Washington

Bob, I know it's been a few years but reading your story and symptoms is very similar to mine.  I have a SLAP 2 tear and a partial tear of the infraspinatus which I have been rehabbing for 3 1/2 months now.  I have seen signifcant improvements where I have almost full range of motion with little to no pain.  My most significant issue is constant clicking/popping in my shoulder which is mostly painless.  As you mentioned, sometimes the pop/click feels good as it almost feels to put the shoulder in the right place.  My overhead activities aren't as strenuous as yours as a climber so I just wanted to see how physical therapy worked for you.

Thanks in advance!

Jim Gallaher

Hi Jim,

        I so infrequently actually log in to this site that it has been some time since I actually checked my postings.  But I did so today and I apologize for not replying earlier.  In answer to your question I found that PT got me pretty far in recover but I know there was more I could do to recover.  So during spring 2017 I decided to keep doing all that my PT therapist had taught me but to begin experimenting on my own and by late summer/early fall 2017 had developed some additional stretch and strengthening activities what have really worked well for me.  For about the last six months or so I have been effectively 100% pain free and have basically the same mobility and strength on my left side (SLAP tear side) as my right.  The tear may never heal but as of now it is no longer something I think about or favor.  My technology skills are not super and I am not on social media so I do not have a sense of how I could demonstrate what I developed for myself.  But I would just encourage you to be creative and experiment.  

Cheers,

Bob Loomis, Spokane, WA.