Overview
what it is and why it mattersYour shoulder socket is shallow on its own: the rim of cushion around it (the labrum) deepens the socket and acts as the anchor point for the biceps tendon. A SLAP tear, short for Superior Labrum Anterior to Posterior, is a tear at the top of that rim, right where the biceps attaches; the name means the tear runs across the top from front to back. The version that matters most is when the biceps anchor itself pulls loose. SLAP tears happen from falling onto an outstretched arm, a sudden hard pull on the arm, or repeated overhead loading: pitchers and other throwers see them most from the twisting forces of throwing.
Symptoms
what you may notice- Deep pain in the front or top of the shoulder, especially with overhead motions like throwing or reaching up
- A catching, clicking, or popping sensation inside the joint during certain arm movements
- Pain that worsens with overhead loading: throwing a ball, serving in tennis, pressing weight overhead
- A dead-arm feeling after throwing: a brief loss of strength or control mid-throw
- Pain with biceps-loading activities: carrying heavy bags, curling, or pulling motions
- Night pain when rolling onto the affected shoulder
Diagnosis
exam first, imaging secondYou will typically have deep shoulder pain with overhead activity, sometimes a clicking or catching feeling. Your provider performs a focused physical exam of the shoulder to reproduce the pain. The best imaging test is an MRI with contrast injected into the joint (MRI arthrography), but SLAP tears are notoriously hard to diagnose with confidence on imaging alone. The gold standard is arthroscopy: looking inside the joint with a small camera, often with treatment in the same setting.
Treatment Path
how care progresses1
Physical therapy
PT focuses on three things: stretching the back of the shoulder capsule (so-called sleeper stretches), strengthening the rotator cuff, and balancing the muscles around the shoulder blade. This works well for many patients, especially older patients with wear-related tears, who often improve enough that surgery is not needed.
2
Activity modification
Cut back on the overhead and throwing activities that loaded the labrum in the first place while the cuff and shoulder-blade muscles catch up.
3
Intra-articular injection
An image-guided steroid injection placed inside the joint reduces the inflammatory pain and also gives diagnostic information; same-day relief from the numbing medicine confirms the joint itself is the source.
Surgical Options
if non-operative care isn't enoughThe decision is age-driven. Younger throwing athletes with a confirmed SLAP tear who have not responded to a structured rehab program are candidates for an arthroscopic labral repair: stitching the labrum back down to the rim of the socket. Older patients with SLAP tears do better with a biceps tenodesis: the biceps tendon is detached from the labrum and reattached to the upper arm bone instead. Tenodesis takes the unstable biceps anchor out of the equation and tends to be more reliable than repair in this older group.
Labrum / SLAP repair
Arthroscopic repair of a torn superior labrum.
Learn about this procedure →Biceps tenodesis
In older patients or those with significant biceps degeneration, releasing the biceps anchor and fixing the tendon to the humerus, often more reliable than repair in this population.
Learn about this procedure →Providers Who Treat SLAP Tear
sports-medicine team
Frequently Asked
questions we hear in clinicWhat is a SLAP tear?
SLAP is short for Superior Labrum Anterior to Posterior. It is a tear at the top of the labrum, the rim of cushion around your shallow shoulder socket, right where the biceps tendon attaches; the name means the tear runs across the top from front to back. The version that matters most is when the biceps anchor itself pulls loose.
How does a SLAP tear happen?
From falling onto an outstretched arm, a sudden hard pull on the arm, or repeated overhead loading. Pitchers and other throwers see them most, from the twisting forces of the cocking phase.
Do I need surgery?
Not always. Many patients improve with physical therapy, activity changes, and a joint injection, especially older patients with wear-related tears, who often improve enough that surgery is not needed. Surgery is considered when a structured rehab program has not worked.
Which surgery would I have?
The decision is age-driven. Younger throwing athletes with a confirmed tear who have not responded to rehab are candidates for an arthroscopic labral repair, stitching the labrum back down to the rim of the socket. Older patients tend to do better with a biceps tenodesis, where the biceps tendon is detached from the labrum and reattached to the upper arm bone instead.
Why is a SLAP tear hard to diagnose?
SLAP tears are notoriously hard to confirm on imaging alone. The best imaging test is an MRI with contrast injected into the joint (MRI arthrography), but the gold standard is arthroscopy: looking inside the joint with a small camera, often with treatment in the same setting.
What does physical therapy involve?
PT focuses on three things: stretching the back of the shoulder capsule (so-called sleeper stretches), strengthening the rotator cuff, and balancing the muscles around the shoulder blade.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: