Shoulder Pain: Is it a “SLAP Tear”?
The shoulder is one of the most complicated joints in the human body, containing a complex network of tendons, ligaments, nerves cartilage and soft tissue. For this reason, shoulders are easy to injury – but the exact cause or type of injury can be difficult to diagnose.
If you are experiencing shoulder pain it could be a “SLAP Tear”. This type of shoulder injury can be very painful, as well as limit motion in the shoulder, especially overhead movements.
In this article board certified hand surgeon Dr. Rehman explains what causes a SLAP Tear in the shoulder, how it is diagnosed, and how it can be treated.
What is a Shoulder SLAP Tear?
SLAP stands for “Superior Labrum Tear from Anterior to Posterior”. The labrum is a piece of cartilage in the inner portion of the shoulder joint. Superior means “on the top” and “Anterior to Posterior” means from front to back. A SLAP tear occurs when there is damage to the top of the labrum, or to the point where the biceps tendon connects to the labrum.
Symptoms of a SLAP tear include deep shoulder pain and decrease in certain shoulder motions. These symptoms typically intensify with certain types of activity, such as lifting objects overhead, throwing a ball or even swinging a bat or golf club.
Athletes with a SLAP tear often experience a decline in sports performance such as a decrease in shoulder power or reduced range of motion. Patients with a SLAP tear may also experience locking, popping, clicking or grinding in the shoulder.
Diagnosing a Shoulder SLAP Tear
Because many shoulder injuries result in pain and limited range of motion, it is almost impossible to identify a SLAP tear by symptoms alone. And, a SLAP tear will not appear on an x-ray because the labrum is made of soft tissue. However, x-rays can identify or rule out other shoulder problems that may be bone-related.
An MRI is usually performed first if a SLAP tear is suspected. While an MRI is the best non-invasive means of diagnosing a shoulder SLAP tear, it is possible for an MRI scan to miss a smaller tear. In these cases, arthroscopic surgery is the best way to confirm if the labrum is torn.
What Causes a Shoulder SLAP Tear?
SLAP Tears most commonly develop over time due to repetitive movements, such as participation in certain sports or industrial activities. But a SLAP tear can also result from acute trauma or age, though this is far less common. Repetitive actions that often lead to a SLAP tear include athletic activities such as weightlifting, tennis, pitching and golfing.
SLAP tears (Superior Labrum Anterior to Posterior) typically result from specific mechanisms that place excessive stress on the superior labrum where it attaches to the biceps tendon. Acute traumatic injuries represent a common cause, particularly falls onto an outstretched arm that transmit force through the hand and arm into the shoulder joint. This mechanism creates a compression force combined with slight forward translation of the humeral head that can avulse the labrum from its attachment to the glenoid.
Overhead athletes face particularly high risk for SLAP tears due to the repetitive stresses placed on the shoulder during throwing motions. The late cocking phase of throwing creates significant tension on the biceps-labral complex, while the deceleration phase produces additional shearing forces across the superior labrum. Baseball pitchers, volleyball players, tennis servers, and competitive swimmers demonstrate higher incidence rates, with studies showing that up to 40% of professional overhead athletes have some degree of SLAP pathology on advanced imaging.
Degenerative SLAP tears develop gradually over time, particularly in individuals over 40, as the labral tissue loses elasticity and becomes more susceptible to fraying and tearing. These age-related changes often occur in conjunction with other degenerative shoulder conditions such as rotator cuff tendinopathy or glenohumeral arthritis. The degenerative process may be accelerated by occupational demands involving repetitive overhead activities or frequent heavy lifting.
Anatomical variations can predispose certain individuals to developing SLAP tears with less significant trauma or activity. These variations include a more vertical alignment of the glenoid, differences in labral thickness or vascularity, and variations in the attachment patterns of the biceps tendon. Genetic factors influencing collagen composition and structure may also play a role in determining individual susceptibility to labral injuries.
Treating a Shoulder SLAP Tear
Nonsurgical SLAP tear treatment is typically recommended first, depending on the type and degree of the tear (e.g. fraying vs. detachment).
Nonsurgical treatments include: elimination of the action or sport that caused it; anti-inflammatory medications to decrease swelling and pain; and physical therapy exercises. This type of treatment program can take from three to six months.
SLAP Tear Surgery may be required in more severe cases to repair the tear and prevent further damage to the shoulder. Th surgical options will vary depending on the type of SLAP tear (location, degree, etc.) and the patient’s age, activity level and health.
Arthroscopic surgery is the most common surgical technique for repairing a SLAP tear, because smaller incisions are made. This means less swelling and discomfort, and a faster recovery process. Generally a sling is needed for the first several weeks after SLAP surgery, followed by prescribed mild exercises or PT.
Recovery after SLAP surgery takes about 6 months. But often times athletes can resume interval activity three or four months after surgery. And the good news is that most patients regain full use of their shoulder following surgery.
Recovery from a SLAP Tear
Recovery timelines for SLAP tears vary significantly based on several factors, including tear severity, treatment approach, individual healing capacity, and compliance with rehabilitation protocols. Non-surgical management typically requires 3-6 months of dedicated rehabilitation before patients return to unrestricted activities, though some individuals with minor tears may progress more quickly. Surgical repair generally necessitates a more extended recovery period of 6-9 months, with overhead athletes often requiring 9-12 months before returning to competitive play.
The initial recovery phase focuses on protecting the healing tissues while gradually restoring range of motion. Following surgical repair, patients typically wear a sling for 4-6 weeks to limit movement that could stress the repaired labrum. During this period, passive motion exercises are introduced under the guidance of a physical therapist, carefully avoiding positions that place tension on the biceps-labral complex. Pain management remains important during this phase, potentially including anti-inflammatory medications, ice therapy, and sometimes ultrasound or electrical stimulation.
As healing progresses, the rehabilitation focus shifts toward restoring normal shoulder mechanics and gradually rebuilding strength. This intermediate phase typically spans months 2-4 of recovery, introducing progressive resistance exercises for the rotator cuff and scapular stabilizers while continuing to improve range of motion. Patients begin functional activities within protected ranges, gradually expanding movement patterns as healing and comfort permit.
The final phase of SLAP tear recovery emphasizes return to specific activities and sports, incorporating sport-specific or occupation-specific training. For overhead athletes, this includes a carefully structured throwing program with gradual increases in distance, velocity, and volume. Throughout this advanced rehabilitation stage, emphasis remains on maintaining proper shoulder mechanics and scapular control to prevent recurrent injury. Complete recovery requires not only healing of the labral tissue but also restoration of the complex neuromuscular control patterns necessary for optimal shoulder function.
Physical Therapy After a SLAP Tear
Physical therapy following a SLAP tear proceeds through distinct phases designed to respect tissue healing while progressively restoring function. The initial phase focuses on protected motion and pain control, utilizing techniques such as gentle pendulum exercises, passive range of motion within safe zones, and modalities to reduce inflammation. Physical therapists carefully avoid positions placing tension on the biceps-labral complex during this early stage, particularly combined abduction and external rotation that stress the superior labrum.
Scapular control represents a cornerstone of successful SLAP rehabilitation throughout all phases. Therapists assess and address abnormal scapular positioning and movement patterns that may have contributed to the original injury or developed as compensatory mechanisms. Exercises focusing on the serratus anterior, middle and lower trapezius, and rhomboids help establish the stable scapular platform necessary for healthy glenohumeral mechanics and protection of the repaired or healing labrum.
As rehabilitation progresses, physical therapists implement carefully sequenced strengthening programs designed to restore the force couples acting across the shoulder. This typically begins with isolated rotator cuff exercises performed in non-provocative positions before advancing to more functional patterns. Biceps strengthening receives particular attention following SLAP injuries, with exercises carefully selected to strengthen the muscle while minimizing tension across the biceps anchor at the superior labrum.
Advanced rehabilitation incorporates neuromuscular training focused on proprioception, kinesthetic awareness, and motor control. These elements prove essential for restoring the precise coordination required for overhead activities and protecting the shoulder from re-injury. Techniques may include rhythmic stabilization exercises, closed-chain training using unstable surfaces, and progressive plyometric activities for overhead athletes. Throughout this progression, physical therapists continuously assess for proper movement patterns, ensuring that patients do not develop compensatory mechanisms that could lead to secondary injuries or recurrent labral damage.
Shoulder SLAP Tear Surgeon – Macomb County
If you are suffering from shoulder pain or limited range of motion, Doctor Rehman will assess and diagnose your shoulder problem, and prescribe the treatment, physical therapy or surgery that is best for your condition.
The sooner shoulder pain and injury is diagnosed and treated, the faster the recovery, the better the results, and the higher the chances that long term problems will be avoided.
