SLAP Tear

Overview

What is a SLAP tear?

At any point in time, 25% of adults will deal with shoulder pain due to injury or overuse. Superior Labrum, Anterior to Posterior tears (SLAP tears), also known as labrum tears, represent 4 to 8% of all shoulder injuries.

Your labrum plays two important roles in keeping your shoulder functioning and pain free. First, your labrum is a cushion for the top part of your upper arm bone. This cushion helps your upper arm bone stay where it belongs – cradled in your shoulder socket. Second, your labrum is a connection point between your shoulder blade socket and one of your bicep tendons.

The S in SLAP refers to the top of your labrum. When this part of your labrum tears, your upper arm bone loses its cushion and your bicep tendon loses its connection to your shoulder blade socket. As a result, your shoulder hurts and feels unstable. The L in SLAP refers to your glenoid labrum.

There are several ways to tear your labrum. SLAP tears are common injuries for people who play sports. Your labrum can be torn by an injury or simply over time as you age.

Some SLAP tears can be treated with rest and physical therapy. But more serious tears require surgery.

What happens if a SLAP tear goes untreated?

Left untreated, SLAP tear symptoms get worse, causing chronic shoulder pain and decreasing your ability to use your arm and shoulder.

How long does it take to recover from a SLAP tear?

It can take up to six months to a year to recover from a SLAP tear.

Symptoms and Causes

What causes SLAP tears?

SLAP tears are caused by:

  • Chronic injury: People who play sports or do exercise that requires lots of overhead motion, such as playing baseball or softball, swimming or lifting weights, are at a risk for SLAP tears. Chronic injury is the most common cause of SLAP tears.
  • Acute injury: If you try to block a fall with your outstretched arm or you use abrupt jerking movements to lift heavy objects.
  • Aging: Your labrum wears out over time. This tear is usually seen in people age 40 and older.

What are SLAP tear symptoms?

Common SLAP tear symptoms include:

  • Shoulder pain that can be a persistent dull ache or a sharp pain deep in your shoulder.
  • Shoulder pain in certain positions, like raising your arm or stretching your arm behind your head.
  • Shoulder pain when you do certain things, like throwing a ball or reaching overhead.
  • Popping noises or a grinding feeling when you move your shoulder.
  • A feeling like your shoulder might pop out of your shoulder blade.

Diagnosis and Tests

How do healthcare providers diagnose SLAP tears?

Providers use the following tests to diagnose SLAP tears and determine treatment

How do healthcare providers help me decide if I should have SLAP tear surgery?

Healthcare providers weigh the following factors when considering surgery for SLAP tears:

  • The tear’s classification. Tears are classified based on location and if the tear affects other areas of your shoulder.
  • Your age.
  • Your typical activities.
  • Previous non-surgical treatment.

Are there different types of SLAP tears?

There are 10 total SLAP types and sub-types. The most common SLAP tear is the Type II tear. Type II tears have seven sub-types, each describing different ways a Type II tear might appear:

  • Type I. In this type of tear, your labrum shows signs of fraying or shredding but still functions. Type I tears are often seen in people who are middle-aged or older.
  • Type II. This is the most common SLAP tear type. In Type II tears, the labrum and bicep tendon are torn from the shoulder socket.
  • Type III. Torn labrum tissue is caught in the shoulder joint.
  • Type IV. In this type, the tear that started in your labrum is tearing your bicep tendon.

Management and Treatment

How are SLAP tears treated?

SLAP tear treatment depends on the amount and kind of damage healthcare providers find when they examine your labrum. They might recommend non-surgical therapies first before concluding surgery is the best option. Regardless, SLAP tears can take months to fully heal.

Here are common SLAP tear treatments:

  • Rest.
  • Anti-inflammatory drugs.
  • Cortisone shots.
  • Physical therapy.
  • Debridement.
  • Arthroscopic labral surgery to repair your labrum.
  • Bicep tenodesis (a surgical procedure for treatment of severe symptoms involving the bicep tendon).

What happens after SLAP tear surgery?

  • You’ll wear an arm sling so your injured shoulder isn’t bearing weight. You might need to wear the sling for several weeks to several months.
  • Your shoulder might feel stiff.
  • Your shoulder might feel weak.
  • You still might have limited range of motion.
  • Your doctor might recommend light exercise or physical therapy to help you regain strength.

Prevention

How can I prevent a SLAP tear?

Some SLAP tears are unavoidable. You might get a SLAP tear if you tried to break your fall with your outstretched arm. But you can also tear your labrum in daily activity like regularly playing sports that use overhead arm movements and lifting things with jerking movements.

Here’s how you can prevent a SLAP tear:

  • Warm up your shoulder muscles with stretches before playing sports.
  • Pay attention to how your shoulders feel, and talk to your healthcare provider if you notice changes such as pain or stiffness.

Outlook / Prognosis

What is the prognosis (outlook) if I have a SLAP tear?

Recovering from SLAP tear treatment is a marathon, not a sprint. It can take three to four months for non-surgical treatment to heal your damaged labrum. It can take up to a year to fully recover from SLAP tear surgery.

Can I re-injure my shoulder and require more SLAP tear treatment?

Recurring, new or more serious SLAP tears are common. People who resume the physical activity that caused the labrum tear can re-injure a healed labrum or cause another tear in another part of the labrum.

Living With

What should I know about living with SLAP tears?

Recovering from SLAP tears and treatment doesn’t mean you can’t participate in sports or other activities. It does mean you need to protect your shoulder from new or recurring injury. Here’s how to do that:

  • If you play sports, be sure to stretch your shoulders before and after your activity.
  • Avoid activity that requires you to repeatedly reach over your head to move or lift things.
  • Pay attention to persistent shoulder pain.
  • Call your doctor if you hurt your shoulder in a fall, or if someone or something yanks hard on your arm.

Questions to ask your doctor:

  • Will my SLAP tear heal without surgery?
  • What are the benefits of non-surgical versus surgical treatment?
  • Which treatment has the fastest rate of recovery?
  • What are the surgery’s side effects?
  • Why does it take so long for SLAP tears to heal?
  • Will the treatment make my pain go away?
  • Will I be able to play sports again?
  • Will I always have trouble moving my arms or reaching overhead?
  • Can I hurt my shoulder again?

A note from Cleveland Clinic

You may not realize how much you use your shoulder until it hurts to use your shoulder. Fortunately, there are several ways to treat SLAP tears. Regardless of the treatment, recovery will take time. Be sure to speak with your healthcare provider if you are having any type of difficulties during your recovery, including emotional issues. Your provider can recommend resources to help you.

Last reviewed by a Cleveland Clinic medical professional on 08/20/2021.

References

  • Arthroscopy-The Journal of Arthroscopic and Related Surgery. Which to Fix – The Biceps or the Labrum? The Shoulder SLAP Tear Is Still Controversial. (https://www.arthroscopyjournal.org/article/S0749-8063(19%2930163-X/pdf) Accessed 9/17/2021.
  • Familiari F, Huri G, Simonetta R, McFarland EG. SLAP Lesions: Current Controversie (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362364/) s. EFORT Open Rev. 2019;4(1):25-32. Accessed 9/17/2021.
  • National Institute of Health. Superior Labrum Anterior Posterior Lesions. (https://www.ncbi.nlm.nih.gov/books/NBK538284/) Accessed 9/17/2021.
  • Sullivan S, Hutchinson ID, Curry EJ, Marinko L, Li X. Surgical Management Of Type II Superior Labrum Anterior Posterior (SLAP) Lesions: A Review Of Outcomes And Prognostic Indicators. Phys Sportsmed. Accessed 9/17/2021.

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