Slap Tear and shoulder pain

I’ve been lurking forums for a few weeks, and you guys seem to have a lot of experience. I haven’t been a weightlifter in a few years now. Recently I got a slap tear on my right shoulder at work, I am a 38 y/o firefighter. MRI says 12 extending posterior to 9 and non detached with bicep tendinosis. I’ve been strongly suggested a bicep tenodesis by surgeon, but this is after some crap pt I have had over the last few months. Can anyone share their experience with a slap tear and some of the things you did to overcome it, surgery, exercises, peptides? Sorry for jacking up these forums, but I’m pretty desperate to avoid surgery would appreciate any advice from experience.

Did you ask your Ortho if you “could” PT through this? I have a slap tear in my left shoulder. I did PT and it took a long time for it to get better, almost a year to pain free. I did PT with a professional for 6 weeks followed by at home exercises. I still do them. Also a strong anti inflammatory helps a lot too. I was prescribed Meloxicam and it worked wonders. Every other year I reagrivate the injury. I’ve been dealing with just this case since Nov last year when I tried maxing on bench. It’s Feb and I’m getting closer to pain free again. This is the third time.

October he told me I could give pt a try. I did well for a while was feeling good then my bicep tendon starting acting up and felt inflamed from pt. I should have took meloxicam sooner, but I have it now. I had to take it easy after a couple months of pt bc I was rear ended in a car, and my back took a while to feel better. Work comp makes things difficult, bc they are trying to make me better by a deadline and have me decide on surgery quicker. My shoulder feels inflamed, but the labrum pain isn’t as bad as it was and it feels more like biceps tendinitis. BC my tear is where my bicep tendon attaches to the labrum the surgeon said it won’t get better, but I have a hard time believing that in the long term. 2nd opinion surgeon told me he would try to avoid the surgery as much as possible and it looked degenerative to him. Tough spot with a pregnant wife. Thanks for replying dude a year to feel better with pt is what I figured

Physiotherapist here

This type of SLAP tear, in your population (active middle aged male) is very commonly incidental and I would recommend strongly considering 12 weeks of high quality rehab

The biceps tendinosis may or may not be best managed surgically based on the degree of degeneration.

Rehabilitation for labral insufficiencies must involve:

  • Getting strong as fuck into external and internal rotation: I recommend starting with your arms by your side, and then progressing to arms overhead
  • Getting strong as fuck on lateral raises of some sort
  • Slowly building strength with some kind of dumbbell curl and some kind of dumbbell fly
  • Take pressing and pulling movements really light until those above isolated movements are very strong and stable

That’s a very vague plan, and that’s because different individuals will respond better to different exercise choices within those guidelines

He likely meant the labral tear won’t magically “seal” back together, however many people can gain very functional shoulders with torn labrums

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Thanks for replying. Mild intra articular bicep tendinosis without tear is what MRI said. My labrum was “frayed” in one ortho opinion and he’s very experienced in athletics, and was team physician for the eagles years ago. Yes the pt has not been great with the therapists telling me I had a deadline from the surgeon to get better. It feels like my bicep tendon is inflamed, and I’m getting pain in my bicep in the middle of my arm as well as the shoulder. I had zero bicep pain, until the body blade exercise I felt sharp pain and exercises like neutral grip lateral raises with bands produced sharp pain in my bicep tendon at shoulder. I’ve been doing a lot of pulling bc that’s when I felt best for a while, but I will definitely try what you mentioned. My brother had this surgery when he was 29, and he feels great. My other brother keeps telling me to take bpc he swears it fixed his shoulder. If any particular exercises you recommend I would appreciate, but I get the gist of what you said. Thanks a lot for the advice

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I will reply more in depth later. I have bilateral SLAP tears and have also been avoiding surgery. I can hopefully point you in the right direction with what has helped me.

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This is generally not a shoulder I would consider an “urgent” surgical candidate. However, other things that affect the surgery decision are:

  • Current range, strength stability
  • Actual visual inspection of the scan
  • Goals

Unfortunately I feel it would be inappropriate for me to provide much extra advice from what I have already. In regards to exercise you basically need to:

  1. Find a shoulder rotation exercise (and load) that you can consistently train and progress with either no symptoms or mild symptoms that don’t worsen post-exercise

  2. Find a shoulder raise exercise (and load) that you can consistently train and progress with either no symptoms or mild symptoms that don’t worsen post-exercise

  3. Find a bicep curl and chest fly exercise (and load) that you can consistently train and progress with either no symptoms or mild symptoms that don’t worsen post-exercise

  4. Taking it easier on pressing and pulling exercises, but find exercises and loads that are pretty much pain-free during and after

Try pronated (empty can) raises or incline lateral raises

Non-detached tear of labrum is what the MRI stated, experienced ortho said it looked like fraying. I’m gonna try and work out some of what you outlined this week and see what I can do without pain. Thanks a lot for the helping me out.

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My reply as promised…

First, a couple disclaimers:

My reasons for avoiding surgery are probably completely different than yours. I have talked with people and read stories from those who have had a biceps tenodesis with great success. There are also some who wish they never had it done. If my specific circumstances were different, I would likely have the surgery and may still do so in the future. So, consider it as a viable option, especially if you are actively competing in something or wish to maintain a physical occupation for years to come.

Second, in addition to SLAP tears, I have also had the pleasure of having to work around numerous other injuries and for the last two years have dealt with COVID-related reactive arthritis/myositis (diagnosed by rheumatologist). I am also limited by equipment, as I work out in my garage. So, the way I lift and the exercises I use are a lot different than what I used to do at my biggest/strongest. If you forgo surgery, there will be some things that you will not be able to do anymore. Accept it. I will tell you what works for me, but given individual anatomical differences and injury history, the bottom line is you will have to figure out what works best for you.

A brief shoulder history:
Left side SLAP tear happened years ago. I don’t know exactly when or how. Never sought treatment/diagnosis, just trained through it with some small adjustments.

Right side SLAP tear was work-related and happened in November of 2022. Was 100% sure after it happened that it was the exact same thing as my left side, only more severe. Went to ortho and got MRI done to confirm SLAP tear. Doc recommended bicep tenodesis, but I opted for 12 weeks of PT instead. PT was okay. Some exercises seemed to help, but most didn’t. I am still in the process of figuring out some things, so I don’t have all the answers, but as far as training goes, I am able to keep my shoulders pain free the vast majority of the time anymore.

I will paint in broad strokes here, so if you have specific questions I can try and answer them, but here are the basics of what has worked for me:

First, let go of the idea of having to do certain lifts or use certain percentages. For instance, I can no longer barbell strict press, so I opt for seated dumbbell press instead. I also used to go heavy overhead, but now I stick with lighter weights (10-15 RM) because having to get the dumbbells in and out of position is a very deliberate process to avoid aggravation.

Second, this whole process is trial and error. I would recommend dropping it down to one single lift per day for a while so you can for sure confirm whether or not it is causing an issue. If you do multiple movements involving the shoulder girdle in one session, and you feel fine the rest of that day, but the next day after DOMS/inflammation set in it hurts, which lift caused it? Once you confirm a movement, then you can add a second lift in on that day next time. Also, it may not be the lift itself, but how you perform it. Try changing grip width a tad, or limiting it to a small ROM where you can maintain solid tension in the target muscle like a big gay bodybuilder. I’ve had to do this with multiple lifts and don’t regret it, even though I used to be a maximal ROM whore. The range will come back with time as the appropriate muscles are able to carry the load better.

Third, there are some injuries where training through some pain is acceptable or even necessary. I do not consider this one of them. Depending on the severity of the tear, your doc was likely right when he told you that it will not heal on its own. The long head of the bicep attaches to the labrum at the site of the tear, and I find most of the pain is associated with too much tension through that tendon. In effect, everytime you are contracting the long head hard against load, there is a likelihood of making the tear worse. A very small amount of pain related to residual bicep DOMS the next day is acceptable, but anything beyond that is not. Train around pain with this injury, not through it.

As far as mobility work and “rehab” exercises go. I don’t do much at all. I think I may have actually torn my left side doing some Kelly Starett mobilityWOD stuff like 7-8 years ago, but I cannot confirm that. I have found that for me, mobility work never seems to have any lasting effect, no matter how often or how hard I do it. I subscribe to the Paul Carter (I think it was him) school of thought where strengthening appropriate muscles under load and slowly increasing ROM over time will yield better mobility. For SLAP tears this would mean strengthening the lats, rotator cuff, and rear delts to really help maintain an appropriate humeral head position and working on improving thoracic extension and strengthening rhomboids to help with proper scapular movement if that is an issue for you as it was/is for me. I have a really long torso and short legs at 6’2’’, which lead to natural upper back rounding and poor thoracic extension along with the apparent inability to truly shorten and activate my rhomboids. Once I realized this, getting my rhomboids firing and focusing on maintaining T-extension throughout certain lifts have made a significant difference. These are the kinds of things you will have to figure out for yourself.

For “rehabbing”, the physio poster above @j4gga2 , whose posts I generally really like, provided some suggestions. Most are good, but a couple need clarification. I agree it is important to be strong in internal and external rotation, but that does not necessarily mean you have to directly train isolated internal/external rotation. Cable external rotations are probably the most prescribed movement for shoulder issues. My PT had me doing them, and they were great at lighting up that infraspinatus and helping suck the head of the humerus back in the socket. BUT, a few months ago I ended up with what I presume are small tears in my clavicular pecs from doing these often. Maybe it was because I was doing them too frequently, or maybe it was from doing them on a low pulley and the angle was causing too much stretch on the clavicular head. I’m not sure, but I won’t be doing them again and have found better alternatives. I prefer movements that hit the desired muscles in a more integrated way. I also disagree with the rec to do dumbbell curls and flys. As far as curls go (and biceps in general for SLAP tears), avoid anything that places emphasis on the long head. You should, however, strengthen the shit out of the short head. The key for me was finding movements that allowed a lot of short head activation with little to no long head activation. This means NO SUPINATION ON ANY PULLING OR CURLING EXERCISES. Focus on neutral and pronated grip for pulling/curls. I would also invest in two kinds of straps if you don’t already have them. Regular lifting straps (I use IronMind) and a set of hooks like these. I use the hooks for certain exercises that used to hurt and found that it takes the load off of the short head tendon so I can still do them and make progress. As far as flyes go, they have never felt good to me and always put too much stress through the biceps. Your mileage may vary.

For specific exercises, I am still working on finding a few things that work, but here is what I use regularly:

Lats -
Barbell rows (with straps) - Some guys don’t like them, but they work well for me. I do use a slightly wider grip than I used to and that seems to shift tension from long head to short head.
Rack chins - I use the Titan angled multigrip bar for these so that I am mostly neutral. Really hammers lats and short head of bicep.
Seated cable rows (with hooks) - I pull a little higher than I used to here as well but still focusing on lats.
Meadows rows may work for you here too. I can’t always do them because of COVID knee/back stuff.

Rhomboids -
Neutral grip pulldowns (with hooks) - I use something like this, but I lean back a bit to really put the tension through the mid-traps and rhomboids. If tension is maintained appropriately, these really hammer the rotator cuff too.
One arm landmine rows - A little different than Meadows version. Can’t find pictures or videos of anyone doing them the same way. Basically I set up the landmine and take a single cable handle attachment and drape it around the end of the bar with a collar just below it to prevent slipping. Then I stand next to the bar, just in front of the weights, with my feet together and do a single arm semi-pronated row really focusing on stretching the rhomboids. This was basically my attempt at a home gym alternative to a hammer-strength machine row.

Rotator cuff -
The two above for rhomboids +
Kneeling landmine press - https://www.youtube.com/watch?v=x071zV-Bo2E follow Meadow’s cues, but I do them from a half kneeling position due to height and I don’t lockout. Really focus on keeping the tension on the back of the shoulder.

Rear delts -
Used to do rear delt flyes/raises all the time, but can’t now due to pec issues. Still looking for an adequate alternative.
Conventional deadlift (with straps) - slow tempo, high reps. Done at the end of a pulling session.
Seated dumbbell press also hits them pretty hard.

Short head Bicep -
Rack chins and Barbell rows
Neutral/slightly pronated DB curls work, but hurt my elbows - I haven’t found a curl yet that placates both my shoulders and my cranky COVID elbows. I don’t care about curls that much though.

Thoracic extension -
Really just being cognizant of it during lifts where it’s needed. I also do some deep scap push ups from the knees/elbows during my warm up before every session to really activate the rhomboids.

As far as programming or a specific routine goes - that is not my area of expertise. I do not like specific rehab protocols and prefer to get that work done within my lifting sessions. I typically follow the idea of “keep what works, get rid of what doesn’t” and usually do typical high intensity, one top set to failure type stuff. The only lifts I will now take close to true mechanical failure are my “new big 3”: incline bench, barbell row, and trap bar deads. Everything else is secondary and I try to stop at the point where muscular tension is lost and compensation begins (emphasis on the try because I really like to push sets). I have also learned the value of your standard 3-4 sets x 10-12 reps on lifts I don’t care about but make my joints/muscles feel good (pulldowns, hyperextensions, etc.). You should train however you will be most consistent, and go slow and light when starting again or trying new movements.

Lastly, anything that works for you for training and rehab is great, but the single biggest issue is changing how you do things during everyday life. I have had to relearn how to pick things up, reach for things, or move things around while at work and at home. Nothing sets me off quicker than flaring up an old injury by doing something stupid and mundane like loading the dishwasher. You said you are a firefighter, so you will really have to be careful with a lot of your regular tasks until you figure out what works and what doesn’t, or you decide to get surgery, if that is something you intend to do until retirement age.

Hopefully some of this helps. Not sure if it was what you were looking for, but if you have any specific questions, I will try and get on here and answer them.

Also, since someone mentioned it……I have not used BPC, but if anyone knows of a reputable/quality source, I would be interested in trying it.

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It is important to provide an isolated rotation stimulus in addition to “integrated” training

As you pointed out, pressing and pulling exercises (and also shoulder raises) are integrated rotator cuff exercises, so by continuing to perform these exercises at non-provocative loads you are ticking off both your “isolated” and “integrated” boxes

Love this!

Firefighter as well. Slap tear 11-3 o’clock. First surgeon wanted to repair the tear and move the connection point of the bicep. I got a second opinion, he (second surgeon) recommended repairing the tear, but not moving the bicep. I went with the second surgeon because I felt it was a more conservative approach.

During surgery obvious type 2 slap tear was found. Repaired with 6 anchors. Was in a sling for 6 weeks 24/7 (excluding showering) Pt started 4 days post op 2 times per week until the 6 week mark, then increased to 3 times a week.

Still in PT 3 times a week, just at two months post op now. ROM sucks, very weak as well, and bicep at shoulder “connection” point is brutal…

Full transparency I’m pretty frustrated with progress. Prior to injury was lifting and BJJ. Now, nothing. Still waking me up multiple times per night. My worry now is a revision surgery to move bicep. I’m sure that worry is a bit early, but its still there. However, pre op had I gone with the first plan of repair with the bicep tenodesis my fear was after returning to work…If I tore it again or ruptured the bicep would there be much left to work with? Or would I be looking at a shoulder replacement? Which, I would really like to stay away from. Thus I chose the more conservative route… in my mind anyway.

If you do end up having the surgery (I know you’re under pressure from worker comp) A circulating ice machine is amazing. And you’re gonna need help, which was a tough one for me. If you have any questions please hit me up. I flip flop daily about if I made a good decision or not. But, I searched all over and just didn’t find many people I could connect with about their experience.