SLAP Tears
What Is the Anatomy of the Long Head Biceps Tendon and Superior Labrum?
The shoulder joint is a ball-and-socket joint formed by the head of the humerus (upper arm bone) and the glenoid (shoulder socket). The glenoid is surrounded by a rim of cartilage called the labrum, which deepens the socket and helps stabilise the shoulder. The long head of the biceps tendon attaches to the top part of the labrum (the superior aspect) and extends from within the joint down the arm. The biomechanical function of this attachment is controversial, but some research suggests it contributes to shoulder stability during overhead and rotational movements.
How Do SLAP Tears Occur?
A SLAP tear (Superior Labrum Anterior to Posterior) is a tear of the top portion of the labrum, where the biceps tendon attaches. It can occur due to:
A fall onto an outstretched arm or a sudden traction injury.
Repetitive overhead activities such as throwing, swimming, or weightlifting.
Degenerative changes in older patients due to gradual wear over time.
Shoulder dislocation or instability episodes.
This injury causes detachment or fraying of the labrum and sometimes involves injury to the long head biceps tendon itself.
What Is the Long-Term Consequence of Having a SLAP Tear?
If left untreated, a SLAP tear can lead to:
Persistent deep shoulder pain, especially with overhead activities or lifting.
A catching, clicking, or locking sensation in the shoulder.
Ongoing inflammation or irritation of the biceps tendon.
Shoulder instability when associated with anterior labral tears.
Development of degenerative changes within the shoulder joint over time.
How Do SLAP Tears Get Diagnosed?
Diagnosis is based on a combination of clinical history, examination, and imaging:
History of shoulder pain, often described as deep or located at the front of the shoulder. Clicking and mechanical blocking of shoulder movement may occur.
Physical examination involving specific tests that reproduce symptoms (such as the O’Brien’s or Speed’s test).
MRI is the imaging of choice to visualise the labrum and biceps anchor and to identify associated injuries such as rotator cuff tears.
X-rays are used to rule out degenerative changes in the shoulder joint.
What Are the Indications for Treating SLAP Tears Non-Operatively?
Non-operative management is the first line of treatment for most SLAP tears, particularly in older or less active patients. It is appropriate for:
Mild symptoms that do not significantly affect daily function.
Degenerative SLAP tears related to ageing.
Patients willing to modify overhead or high-demand activities.
Absence of major instability or associated structural damage.
Treatment focuses on physiotherapy to strengthen the rotator cuff and scapular stabilisers, improve shoulder mechanics, and restore range of motion. Anti-inflammatory medication and occasional corticosteroid injections may help reduce pain and inflammation.
What Are the Indications for Treating SLAP Tears Operatively?
Surgical management is considered when:
Symptoms persist after at least 3–6 months of structured non-operative treatment.
The tear is associated with significant instability, mechanical symptoms, or biceps involvement.
The patient is a young or high-demand overhead athlete requiring full shoulder stability and power.
The SLAP tear is traumatic and significantly detached from the glenoid, causing mechanical blocking of motion.
Surgical options include arthroscopic labral repair (reattaching the torn labrum to the glenoid) or, in some cases, biceps tenodesis or tenotomy—particularly in older patients or those with degenerative biceps tendon changes. The choice depends on the patient’s age, activity level, and the extent of injury.
