Written By: Chloe Wilson BSc (Hons) Physiotherapy
A SLAP tear is when there is damage to the ring of cartilage on the socket of the shoulder joint, known as the labrum.
It stands for “superior labral anterior to posterior tear”, meaning a tear of the upper rim of the labrum from front to back.
The glenoid labrum is most commonly injured by a fall or from repetitive overhead movements, such as racket sports or throwing activities.
Symptoms of a SLAP lesion include pain, weakness, instability and a catching sensation in the shoulder. Treatment usually involves medication and physical therapy, but in some cases, surgery will be advised.
Here, we will look at the common causes, symptoms and treatment options for a SLAP tear.
A SLAP tear occurs in the glenohumeral joint. This is where the top part of the arm bone (the head of humerus), which is shaped like a ball, fits in a socket on the front of the shoulder blade (glenoid fossa).
The shoulder socket is very shallow, similar to a golf tee, to allow for lots of movement. To improve the stability of the shoulder, there is a ring of cartilage, known as the glenoid labrum, which helps to deepen the socket without restricting movement. The glenoid labrum is reinforced by the tendons of various muscles of the shoulder.
With a SLAP tear, the top part of the glenoid labrum, which is reinforced by one of the biceps tendons, is torn. This top part of the labrum tears from away from the glenoid socket from front to back (anterior to posterior), often damaging the biceps tendon as well resulting in biceps tendonitis.
There are a number of different types of lesion, depending on the nature and severity of the injury. The four most common types of SLAP tear are:
Degeneration (wear and tear) where the edges of the labrum fray, but
stay attached to the glenoid rim. Biceps tendon is unaffected
Type 2: The superior (top) part of the labrum and the biceps tendon are torn off the glenoid rim
Type 3: A bucket-handle tear of the labrum where part of the rim detaches forming a flap which can get caught in the joint, causing locking or catching sensations. The biceps tendon is unaffected
Type 4: A bucket handle tear of the superior glenoid labrum which extends into the biceps tendon
Type 1 and type 2 SLAP tears are the most common.
Slap tears can also be associated with a Bankart Lesion, where there is damage to the bottom part of the glenoid labrum, or a rotator cuff tear, damage to the shoulder muscles. You can find out more in the Bankart Lesion and Rotator Cuff tear sections.
SLAP tears can develop suddenly through a one-off event, known as an acute injury, or gradually from repetitive movements, known as a chronic injury.
Acute injuries tend to affect younger people, under the age of 40. SLAP tears are typically caused by:
Chronic tears tend to occur in people over the age of 40, and degeneration of the glenoid labrum is often seen as part of the normal aging process.
Chronic SLAP tears are usually caused by:
The most common SLAP tear symptoms are:
Your doctor should be able to diagnose a SLAP tear from talking to you and examining your shoulder. They may also want to get x-rays or an MRI, often with contrast dye to get a clearer picture.
SLAP tear treatment will depend on the type of lesion and the associated symptoms. Generally, conservative (i.e. non-surgical) treatment is tried first and if this fails, surgery will be considered.
Conservative, i.e. non surgical, treatment for a SLAP lesion will likely include:
If you are still having problems after three to six months of rehab,
SLAP repair surgery may be advised. SLAP tear surgery is usually done
arthroscopically, keyhole surgery. A small camera known as an arthroscope is
inserted into the shoulder joint so the surgeon can see exactly what
damage has been done.
Surgical technique will depend on the type of tear. During SLAP tear surgery, the surgeon will debride (clean up) any frayed edges, and then either remove or reattach and torn parts of the glenoid labrum.
When reattaching torn segments, anchors are inserted into the bone of the shoulder socket and the torn glenoid labrum is sewn back together and held in the correct place with sutures attached to the anchors.
Following SLAP tear surgery, you will need to wear a sling initially for a few weeks (including in bed) to allow the shoulder to heal.
You will work with a physical therapist on a progressive rehab programme to regain the movement, strength and stability of your shoulder - you can find examples of helpful exercises in the rotator cuff exercises section. It usually takes 4-6 months to return fully to sports.
SLAP tear surgery is successful at reducing pain and instability and restoring function in most cases and complications are rare.
There are other problems that can affect the glanoid labrum as well. A Bankart lesion is commonly associated with shoulder dislocations and is where the bottom part of the labrum get torn. There tends to be more shoulder instability associated with it than with SLAP tears - you can find out more in the Bankart Lesion section.
Page Last Updated: 24/11/2020
Next Review Due: 24/11/2020