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What is a SLAP tear?

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A SLAP tear is a certain type of shoulder injury that is common in throwers, but can occur in anyone if there is a pulling or jerking injury of the shoulder.  It is a specific type of glenoid labrum tear of the shoulder, and is different from the other types of labral tear in many ways.  I get a lot of questions about SLAP tears and want to address some of the most common.

The term SLAP tear is an acronym for Superior Labrum Anterior to Posterior tear.  The labrum is a fibrocartilage rim attached to the shoulder socket (glenoid) that gives the shoulder socket more stability.  At the top of the socket, the long head of the biceps tendon attaches to the glenoid and to the superior labrum.  With certain injuries, excess tension is placed on the biceps tendon, which can result in the superior labrum tearing away from the bony socket.  This is the mechanism that causes SLAP tears.

Once the superior labrum is torn, any tension on the biceps tendon (e.g. lifting a heavy object or an overhead throwing motion) places strain on the torn labrum and can cause pain.  There are many subtypes of SLAP tears, and the classification system is based on the severity of the tear and the involvement of the biceps tendon in addition to the superior labrum.

Many SLAP tears can be treated non-operatively with a combination of medications, specific exercises, and activity modification.  Certain sets of patients may not be able or willing to modify their activities, such as throwers/pitchers, overhead athletes like tennis or volleyball players, or workers such as painters or builders who do heavy lifting or overhead work.  These patients may benefit from surgery to address the SLAP tear so that they can get back to their sport or to their job without pain.

Surgical treatment in young people and athletes usually involves a repair of the tear to restore the original anatomy.  Treatment in people over the age of 40 is a little more controversial in the orthopedic community.  It the recent past, SLAP tears were probably repaired too often in older people, but now the general consensus is that repair in older individuals may lead to excessive stiffness of the shoulder.  The treatment of these cases involves debriding, or trimming, the labral tear, and then releasing the biceps tendon from its attachment on the superior glenoid and labrum.  After the tendon is released, it can either be left free or it can be reattached to a different spot on the bone of the humerus.

I always try to explain these considerations to my patients with SLAP tears, and then we formulate a treatment plan based on that patient’s specific circumstances.  If you have a SLAP tear, I encourage you to ask a lot of questions before proceeding with any type of surgery.

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