Shoulder Labral Tears

A SLAP tear is a tear at the top of the labrum, the rim of cartilage around the shoulder socket, right where the biceps tendon anchors to the bone. It can develop gradually from years of overhead loading or happen in a single event such as a fall or a hard pull on the arm. Degenerative tears are more common in older adults and often respond well to nonsurgical care, while traumatic tears in younger throwing athletes more often need surgery. The torn tissue does not typically heal back on its own.

Deep pain inside the shoulder, hard to pinpoint, is the most common complaint. Common symptoms include:

• Deep pain at the front or top of the shoulder, worse with overhead activity or throwing
• A catching, clicking, or popping sensation during certain arm movements
• Pain with pressing weight overhead, pulling, or biceps-loading tasks such as curling
• A dead-arm feeling after throwing, with brief weakness or loss of control
• Night pain when lying on the affected shoulder

Your provider performs a focused exam to assess motion, strength, and stability, though a SLAP tear lies deep inside the shoulder and is hard to identify from the exam alone. The best imaging study is an MRI with contrast injected into the joint, but even then a tear can be hard to see. The definitive way to confirm the diagnosis is arthroscopy, in which a small camera examines the labrum directly.

Most people, particularly those with degenerative or wear-related tears, begin with nonsurgical care:

• Physical therapy to stretch the back of the shoulder, strengthen the rotator cuff, and balance the shoulder-blade muscles
• Activity changes to reduce the overhead and throwing motions that load the biceps anchor
• An image-guided corticosteroid injection to calm inflammation and relieve pain

Surgery is considered when a structured therapy program has not provided adequate relief, particularly for patients returning to high-demand overhead activity. The procedure either reattaches the torn labrum or, in older patients, moves the biceps anchor out of the joint, depending on age and the condition of the anchor.

• Shoulder arthroscopyShoulder

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• SLAP Tears in the Shoulder — AAOS OrthoInfo