Superior Labrum (SLAP) Tear

The shoulder is one of the most mobile joints in the body, allowing a wide range of motion for lifting, reaching, and throwing. The ball-and-socket structure includes:

• The humeral head (ball)
• The glenoid (socket of the shoulder blade)
• The labrum, a rim of cartilage surrounds the socket, deepening it to stabilize the joint
• The rotator cuff, which controls movement and keeps the joint centered

The biceps tendon attaches at the top of the glenoid, anchoring into the labrum. A SLAP tear occurs when this attachment site or surrounding cartilage becomes injured—either through trauma or repetitive motion.

Depending on the extent and location, SLAP tears are categorized into several types (I–IV).

• Type I: Fraying of the labrum, often age-related.
• Type II: Detachment of the labrum and biceps anchor (most common).
• Type III: Bucket-handle tear of the labrum without biceps involvement.
• Type IV: Tear extending into the biceps tendon.

SLAP tears are relatively common, especially in active adults and athletes, although they are often asymptomatic. They are often seen in:

• Throwing athletes (baseball, softball, volleyball)
• Weightlifters, especially during bench press or military press
• Workers or hobbyists who perform repetitive overhead motions
• Individuals over 40, in whom degenerative fraying of the labrum is common

These injuries can also occur from a fall onto an outstretched arm, a sudden pull on the biceps, or lifting a heavy object with the arm extended.

Because symptoms overlap with other shoulder conditions—like rotator cuff tears or impingement—SLAP tears can sometimes be difficult to diagnose without specialized evaluation. Additionally, imaging findings interpreted by a radiologist as a SLAP tear may be normal adaptation to repetitive activities such as throwing.

Diagnosis begins with a thorough history and physical examination. Dr. José Vega, Cleveland’s trusted shoulder specialist, will ask about your activity level, mechanism of injury, and symptoms, then perform specific tests to evaluate shoulder stability and function.

Common symptoms include:

• Deep pain inside the shoulder, especially with overhead movement
• Popping, clicking, or catching sensations
• Weakness when throwing or lifting
• Pain when lying on the affected shoulder
• A sense of instability or fatigue with repetitive motion

During the physical exam, Dr. Vega will perform maneuvers—such as the O’Brien test or Speed’s test—to reproduce symptoms and assess the integrity of the biceps-labrum complex.

Imaging studies help confirm the diagnosis:

• MRI with contrast (MR arthrogram) provides the most accurate view of the labrum and biceps attachment.
• Ultrasound can evaluate the biceps tendon and surrounding structures.
• X-rays may be used to rule out bone abnormalities or arthritis.

Because SLAP tears often coexist with other shoulder injuries, a complete diagnostic workup is essential for proper treatment planning.

Treatment depends on the type of tear, patient age, activity level, and symptom severity.

Nonsurgical Treatment

For mild or degenerative SLAP tears—especially in older or low-demand patients—conservative care may be effective. This includes:

• Physical therapy to strengthen the rotator cuff and shoulder stabilizers, improving joint mechanics.
• Anti-inflammatory medications or corticosteroid injections to reduce pain and swelling.
• Activity modification, avoiding repetitive overhead or heavy lifting motions until symptoms improve.

With consistent rehabilitation, many patients experience significant improvement within 6–12 weeks.

Surgical Treatment

If symptoms persist or instability remains despite therapy, arthroscopic surgery may be recommended.

The procedure is minimally invasive and tailored to the type of SLAP tear:

• Labral repair: The torn labrum is reattached to the glenoid using small anchors and sutures.
• Biceps tenodesis or tenotomy: In cases where the biceps tendon is involved (especially in older patients), the tendon is released or reattached lower on the arm bone to relieve pain and restore function.

Surgery is performed on an outpatient basis, and patients usually begin a structured rehabilitation program soon after.

After surgery, the arm is protected in a sling for 6 weeks, followed by gradual motion and strengthening exercises under the supervision of a physical therapist.

Typical recovery timeline:

• 0–6 weeks: Sling protection, gentle passive motion.
• 6-12 weeks: Active range of motion and gradual strengthening.
• 3 months and beyond: Advanced strengthening, stability, and endurance work, return to sport or heavy lifting activities.

Most patients regain excellent shoulder strength and stability with a full commitment to rehabilitation.