SLAP stands for superior labrum, anterior to posterior. It is a tear of the top rim of the shoulder socket, at the spot where the biceps tendon attaches inside the joint. It is common in throwing athletes, in people who lift overhead, and after a fall onto an outstretched arm.
SLAP tears can be hard to pin down, because deep shoulder pain and clicking overlap with other shoulder problems, and the labrum changes with age. The diagnosis combines the history, specific exam tests, and an MRI, often with contrast.
Symptoms
Common complaints include:
- Deep, hard-to-localize shoulder pain, often with overhead activity
- Clicking, catching, or a popping sensation in the shoulder
- Pain or loss of velocity in throwing athletes
- Pain with lifting or pressing overhead
How it is diagnosed
Diagnosis combines specific provocative exam tests with an MRI, sometimes with contrast injected into the joint to outline the labrum. Because labral changes are common with age, the exam and the patient's activity matter as much as the image in deciding whether a tear is the source of symptoms.
Many SLAP tears improve without surgery. Dr. Lee starts with a rehabilitation program focused on the rotator cuff, shoulder blade, and, in throwers, the whole kinetic chain, along with activity modification. Injections such as PRP can be helpful in certain cases.
When surgery is warranted, the choice is tailored to age and activity. In younger patients the labrum is repaired with suture anchors; in many older patients, or where the biceps anchor is the pain source, a biceps tenodesis, which reattaches the biceps tendon outside the joint, is more reliable than repair. Matching the procedure to the patient is the key decision.
Non-surgical treatment
Most SLAP tears begin with rehabilitation, restoring rotator-cuff and shoulder-blade strength and, in throwers, correcting mechanics, along with activity modification and anti-inflammatory measures. Many patients improve enough to avoid surgery. Use of injections such as PRP can be helpful.
Surgical treatment
When symptoms persist, surgery is arthroscopic. Younger patients usually have the labrum repaired with suture anchors. In older patients, or when the biceps anchor is the problem, a biceps tenodesis reattaches the biceps tendon and tends to be more reliable and predictable.
Recovery timeline
Recovery depends on the procedure:
- Weeks 0 to 4Sling to protect the repair or tenodesis. Begin gentle, guided motion.
- Weeks 4 to 12Progressive range of motion and rotator-cuff strengthening.
- Months 3 to 6Sport-specific strengthening and a graded return to throwing or overhead lifting.
What patients commonly misunderstand
What the imaging does not settle:
- A labral change on MRI is not always the cause. The labrum changes with age, so an MRI finding does not by itself mean it is the source of pain. The exam and your activity level matter in deciding whether to treat it.
- Repair is not always best. In many older patients, repairing a SLAP tear is less reliable than a biceps tenodesis. The right procedure depends on age and activity, not a single rule.
This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.