SLAP Tears

Superior labrum anterior to posterior (SLAP) tears (sometimes called SLAP lesions) are one of the most common shoulder injuries. Your shoulder is a ball-and-socket joint where your upper arm connects to your shoulder blade.

SLAP tears happen when the labrum (a ring of cartilage that cushions and connects the shoulder socket) is damaged in the area where it attaches to the biceps tendon inside your shoulder joint.

These tears go from the front to the back of the area where the biceps tendon attaches. When they happen, your joint has less cushioning and connection. Sometimes, the biceps tendon is also damaged.

Athletes who do a lot of overhead arm motions – like baseball, basketball, tennis and volleyball players – are especially prone to SLAP tears. But they can happen to anyone. Repetitive use, accidents and aging can also cause them.

SLAP tears can range from mild (with minor fraying) to severe, where the labrum detaches from the shoulder socket. They can make your shoulder uncomfortable or painful, unstable and unable to work properly. They can also limit your range of motion. 

By understanding SLAP tears, you can recognize signs and symptoms, get medical care and take steps to prevent future injuries.

SLAP tear symptoms

If you have a SLAP tear, you may notice:

• Shoulder pain, especially when you move your arm overhead or lift objects 
• A catching, grinding or popping sensation in the shoulder joint
• Weakness in the arm
• Decreased range of motion
• Instability or looseness in the shoulder

Causes of SLAP tears

A lot of different factors can cause SLAP tears. They are commonly caused by:

• Trauma or injury, such as a fall onto an outstretched arm, a blow to the shoulder or an auto accident
• Repetitive overhead movements, which often happen in sports like baseball, tennis or weightlifting 
• Pulling on the arm or lifting a heavy object with force
• Aging, since the shoulder labrum weakens over time and is more likely to tear

Diagnosing SLAP tears 

If you have symptoms of a SLAP tear, you’ll want to see a health care provider as soon as possible. SLAP tears can have symptoms that are similar to other shoulder injuries and can happen at the same time as other injuries, such as rotator cuff tears or shoulder impingement. So it’s important to see an expert for diagnosis. 

Treating SLAP tears early can make healing more successful and can help prevent more damage to your shoulder. 

To diagnose a SLAP tear, your provider will likely consider:

• Your medical history, including what symptoms you have, when they started, what your pain feels like and anything that might have caused an injury.
• Physical examination, with tests to examine your shoulder strength, range of motion and stability. 
• Imaging studies such as X-ray, magnetic resonance imaging (MRI) or arthrograms, which use a contrast dye injected into your shoulder to better show injured soft tissue.
• Specialized tests to check the stability of the labrum. 

There are four types of SLAP tears:

• Type 1: The labrum is frayed but not detached from the shoulder.
• Type 2: The labrum and the biceps tendon are detached from the shoulder.
• Type 3: The labrum tear looks like a crescent shape and the bicep isn’t affected.
• Type 4: The labrum tear looks like a crescent shape and the biceps tendon is detached.

Treating SLAP tears

Your provider can help you find the treatment plan that’s best for your injury, based on its size and location and your overall health. It’s important to treat SLAP tears — otherwise, they can get worse and limit how much you can use your arm and shoulder.

Rest, ice, physical therapy, steroid injections and surgery can treat SLAP tears. Medications such as over-the-counter (OTC) or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation. Acetaminophen may also help reduce pain.

A physical therapist can work with you to build strength in the muscles around your shoulder joint so it’s more supported and stable. They can also help you improve your range of motion, flexibility, posture and biomechanics (body structure) so you don’t put too much stress on your shoulder.

Surgery for SLAP tears 

SLAP tears can often be treated without surgery. But if non-surgical treatments don’t work or you have a complex SLAP tear, you may need surgical treatment. 

If you need surgery, your provider may recommend arthroscopic repair. That’s a procedure where a surgeon inserts a small camera (arthroscope) and specialized instruments through small incisions in the shoulder. 

The surgeon can examine and repair the labrum with little trauma to other areas. Arthroscopic repair usually has less pain and scarring and a shorter recovery time than traditional, open surgery. Most people go home the same day.

The risks from the procedure are usually minor. They include infection, bleeding, blood clots and shoulder stiffness.

Rehabilitation 

After surgery, you’ll need rehab to help your shoulder heal. Your health care team can explain what to expect during the rehab process. It generally includes three phases:

• Phase 1: For the first two to six weeks, you will likely wear a sling to protect your shoulder while it heals. You may need pain medication. Ice may help with pain and swelling. Your physical therapist may recommend gentle range-of-motion exercises such as carefully swinging your arm or using your other arm to guide the recovering arm through movements.
• Phase 2: In weeks six to 12, you’ll expand your range-of-motion exercises to increase your mobility and start to strengthen the muscles surrounding the shoulder. Your physical therapist may recommend exercises where you strengthen the muscles without moving the joint (isometric exercises), as well as exercises with resistance bands.
• Phase 3: After 12 weeks or so, you’ll be able to start reintroducing daily activities and exercises specific to your sport. 

Keep in mind that recovery takes time, and you’ll need to progress slowly. Talk to your health care provider about any concerns or changes. It’s important to follow your rehab plan and attend your physical therapy appointments so you can recover as quickly and completely as possible. 

Preventing SLAP tears 

It’s common for people who have had SLAP tears to re-tear the healing site or to tear the labrum in a different place. While you can’t always prevent SLAP tears, you can take these steps to lower your risk:

• Warm up your muscles and joints before physical activity.
• Use proper techniques in sports and daily activities.
• When you’re starting a new exercise routine, build up gradually.
• Build shoulder and muscle strength with strengthening exercises. Stretching and strengthening are especially important for people who have already had SLAP tears.
• Use good posture so you don’t strain your shoulders. 
• See a health care provider if you notice any signs of shoulder problems. If you treat shoulder injuries early, you might be able to keep them from getting worse.

Key points

SLAP tears are one of the most common types of shoulder injuries. They can strike anyone; however, athletes who do a lot of overhead activity and older people are at higher risk. Some SLAP tears heal with physical therapy. More serious tears may need surgery.

An orthopedic specialist at Banner Health can evaluate your injury and help you come up with a personalized treatment plan to help you return to the sports and activities you enjoy.