Superior Labral Tear (SLAP Tear)

Overview

The shoulder joint is formed where three bones meet: the humerus (long bone that forms the upper arm), the scapula (shoulder blade), and the clavicle (collarbone). The head of the humerus bone fits inside a cavity of the scapula called the glenoid fossa. Inside the glenoid fossa is a ring of cartilage, called the labrum. The labrum serves multiple important functions for the shoulder, like:

• Providing stability for the shoulder joint by “hugging” the head of the humerus
• Providing cushion for the shoulder joint, protecting the humerus bone and the scapula from grinding against each other
• Serving as a connection point for various shoulder ligaments
• Serving as a connection point for the long head of the bicep tendon

When the top (superior) portion of the shoulder labrum tears, this is referred to as a SLAP tear. The superior portion of the labrum is where the long head of the biceps tendon attaches. This tendon may also be injured in a more severe SLAP tear.

A SLAP tear can occur either in the front (anterior) or back (posterior) portion of the labrum.

What causes Superior Labral Tear (SLAP Tear)?

SLAP tears can occur due to a traumatic event, like a fall, or by repetitive overhead motion.

• How the Injury Occurs: The injury develops when excessive force or repeated overhead stress overwhelms the labrum’s ability to stabilize the shoulder.
• Common Everyday Causes: Falls, lifting heavy objects overhead, sudden pulling motions, or repetitive shoulder use during work or exercise.

Common causes of SLAP tears include:

• Falling onto the arm when it’s stretched out: Sudden impact forces the shoulder joint backward, stressing the labrum.
• Repetitive, forceful overhead movement: Heavy overhead lifting places repeated strain on the labrum and biceps anchor.
• Repetitive overhead motions: Continuous throwing or swimming motions gradually wear down the labral tissue.

SLAP tears are categorized by severity and involve four stages of tearing:

• Type I: Mild wear causes fraying of the labrum without detachment.
• Type II: The labrum and biceps tendon pull away from the socket due to stress or trauma.
• Type III: A bucket-handle tear forms, allowing the torn labrum to hang into the joint.
• Type IV: The labrum and biceps tendon both tear, creating joint instability and pain.

SLAP tears are common in these sports:

• Baseball: Repeated throwing motions strain the labrum over time.
• Football: Falls, tackles, and collisions place sudden force on the shoulder.
• Swimming: Continuous overhead strokes stress the shoulder joint.
• Weightlifting: Heavy overhead lifts overload the labrum and biceps tendon.

Symptoms

A SLAP tear can cause symptoms that vary from person to person. Some people notice pain only during certain activities, such as throwing, lifting overhead, or reaching behind the body, while others have more constant discomfort. Symptoms often become more noticeable with specific shoulder movements or athletic activities.

If you have a SLAP tear, you may experience one or more of the following shoulder labrum tear symptoms:

• Pain when performing overhead movements
• A popping, clicking, or grinding sound when moving the shoulder
• Loss of strength in the affected arm
• In later stages, loss of range of motion of the shoulder

Non-operative treatment

SLAP tear treatment will vary depending on the severity and type of the tear (Type I, II, III, or IV)

Type I SLAP tears can generally be treated using non-operative treatments. If you’ve been diagnosed with a type 1 SLAP tear, non-operative treatments that can help you recover from a SLAP tear include:

• Avoiding overhead motions, like throwing
• Non-steroidal anti-inflammatory medications, like naproxen or Ibuprofen, to reduce inflammation and relieve shoulder pain while throwing.
• Physical therapy with a qualified professional in order to strengthen the muscles around the shoulder and to stretch the shoulder in order to restore full range of motion

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Superior Labral Tear

Surgical Treatment

If non-surgical slap tear treatments do not alleviate pain, your doctor may suggest surgical treatment. The type of surgery your doctor suggests will depend on the severity of the tear and whether the tear occurred in your dominant arm or your non-dominant arm. If the tear is minimal, your surgeon may decide to either remove the torn tissue (this is called a debridement procedure) or reattach the torn portion of the labrum.

If a SLAP tear is a high-grade tear or involves the biceps tendon, your surgeon may decide to detach the bicep ligament from the labrum and attach it to the humerus. This procedure is called a biceps tenodesis.