Overview
The labrum is a ring of firm cartilage around the rim of the shallow shoulder socket (the glenoid). It deepens the socket enough to hold the ball of the joint in place. It also anchors the long head of the biceps tendon at the top. A SLAP tear (Superior Labrum Anterior-to-Posterior) damages this anchor at the top of the socket. Either the labrum peels off the rim, or the root of the biceps loses its grip. The usual causes are a forceful overhead throw, a hard pull on the arm, or a fall onto an outstretched arm.
When the biceps anchor fails, the shoulder loses a key stabilizer. Overhead athletes feel deep pain at the back of the joint when they throw. The pain peaks late in the wind-up, just before the arm comes forward. Non-athletes often describe a vague clicking or catching that gets worse with reaching or lifting overhead. The symptoms can mimic a rotator cuff problem. That is why we need both an exam and an MRI arthrogram to confirm the diagnosis before surgery is considered. An MRI arthrogram is an MRI taken after contrast dye is injected into the joint. Tears that are simply frayed or worn at the edge can often be managed without repair. Tears that loosen the biceps anchor, in a patient who needs that anchor intact, are the ones that benefit from surgery.
How the Procedure Works
The first decision is repair versus tenodesis, and it matters. Tenodesis means detaching the biceps from the labrum and reattaching it lower on the bone. For a younger overhead athlete with a clean tear and a healthy biceps tendon, we repair. The labrum is stitched back to the rim of the socket with small anchors. That rebuilds the biceps anchor and restores the labral bumper. For an older patient, a recreational athlete, or anyone with a worn biceps tendon, a repair is unlikely to hold and often causes stiffness. In those cases a biceps tenodesis reliably relieves the pain without depending on the labrum to heal.
When we do repair, we first prepare the rim so the bone bleeds and can heal. Then we set the stitch tension so the labrum sits at the rim without being pulled too tight. Making the biceps anchor too tight is what costs throwers their outward rotation and ends careers.
When to Consider Labrum / SLAP Repair
We generally offer labrum / SLAP repair when symptoms, imaging, and a full course of non-surgical care all point to surgery as the next step. The typical picture includes:
Symptomatic SLAP tear in a young athlete
A tear causing deep shoulder pain with overhead activity, in a patient still at the peak of their sport.
Mechanical symptoms
Catching or clunking with overhead motion that has not responded to therapy.
Failed non-operative care
A course of therapy and rest that has not returned the athlete to sport.
Treats: Shoulder labral tear (SLAP)
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause lasting deep shoulder pain with overhead activity, popping or catching, and a sense of looseness that limits sports. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before labrum / SLAP repair include:
- bleeding and infection
- anesthesia risk
- stiffness, especially loss of the ability to rotate the arm outward
- pain that stays if the labrum is not the true source of the pain
- irritation from the suture anchors
- short-lived nerve irritation from arm positioning or the nerve block
We proceed when a painful SLAP or labral tear is confirmed on exam and imaging, in someone whose activities demand a stable labrum. If the operation is not right for you, we will say so.
Frequently Asked
questions we hear in clinicHow do you know it's a SLAP tear and not a rotator cuff problem?
The symptoms can mimic a rotator cuff problem. That is why we need both an exam and an MRI arthrogram, an MRI taken after contrast dye is injected into the joint, to confirm the diagnosis before surgery is considered.
Does every labral tear need surgery?
No. Tears that are simply frayed or worn at the edge can often be managed without repair. The tears that benefit from surgery are the ones that loosen the biceps anchor, in a patient who needs that anchor intact.
What is the difference between a repair and a biceps tenodesis?
A repair stitches the labrum back to the rim of the socket with small anchors, rebuilding the biceps anchor. Tenodesis means detaching the biceps from the labrum and reattaching it lower on the bone. For a younger thrower with a clean tear and a healthy biceps tendon, we repair. For an older patient, a recreational athlete, or anyone with a worn biceps tendon, a repair is unlikely to hold, and a tenodesis reliably relieves the pain without depending on the labrum to heal.
Will the repair cost me my throwing motion?
That risk is exactly why stitch tension matters. We set it so the labrum sits at the rim without being pulled too tight; making the biceps anchor too tight is what costs throwers their outward rotation. Stiffness, especially loss of outward rotation, is one of the risks we discuss before surgery.
What if my pain does not go away after surgery?
Pain that stays if the labrum is not the true source is a known risk, which is why we proceed only when a painful tear is confirmed on exam and imaging, in someone whose activities demand a stable labrum.
Further Reading
External patient-education references and related OSI pages for additional background:
