What is a SLAP lesion and how is it treated?

Have you been diagnosed with a SLAP tear, or know someone who has a SLAP tear? Chances are you are probably reading this post because you do. So, what is a SLAP tear anyway? SLAP is the acronym for Superior Labrum Anterior-Posterior lesion, which is a tear in the superior posterior labrum of the shoulder.

The shoulder joint is a ball and socket joint, which can be depicted like a golf ball on a tee for comparable size ratio.


The lip of the tee is what keeps the golf ball on the tee and prevents outside forces like a gust of wind from knocking the ball off. The labrum in the shoulder is responsible for keeping the ball, or head of the humerus, in the socket. If there is a tear in the labrum, the ball can roll out of the socket. This is termed instability in the shoulder joint, which can be painful clicking with arm movement, decreased or apprehensive range of motion, and decreased function.

Sports%20Shoulder%20Injuries%20_%20The%20Shoulder%20_%20Labral%20TearThe superior portion of the labrum is naturally more prone to injury, due to the reduced blood supply to this section. Therefore as we age, there is a decreased potential for healing because our blood supply decreases overtime. Many SLAP tears are a result of wearing down of the labrum that occurs slowly over time. In patients over 40, tearing or fraying of the superior labrum can be seen as normal process of aging. Acute injury to the labrum can cause a tear resulting from a motor vehicle accident, a fall onto an outstretched arm, forceful pulling on the arm, such as when trying to catch a heavy object.  In overhead athletes such as throwers, swimmers, and tennis players, a SLAP lesion usually occurs as a result of a peel-back mechanism when the shoulder is in maximal external rotation.


Peel back mechanism occurs in the late cocking phase of a pitcher’s mechanics

SLAP lesions may occur in isolation or in conjunction with other injuries such as a rotator cuff tear. Research has shown that as much as 73% of baseball pitchers with SLAP lesions also have partial thickness tears of the rotator cuff. And 80-90% of baseball pitchers have some sort of labral pathology.

Common symptoms of a SLAP tear are similar to many other shoulder problems, which include

  • A sensation of locking, popping, catching, or grinding
  • Pain with movement of the shoulder or with holding the shoulder in specific positions
  • Pain with lifting objects, especially overhead
  • Decrease in shoulder strength
  • A feeling that the shoulder is going to “pop out of joint”
  • Decreased range of motion
  • Pitchers may notice a decrease in their throw velocity, or the feeling of having a “dead arm” after pitching.

If these symptoms are affecting your everyday function or your ability to complete work tasks then a visit to the doctor will help identify the cause of your pain.

During your visit, your doctor will talk with you about your symptoms and ask about any work activities or sports that aggravate your shoulder. They will also check your range of motion, strength, and stability of your shoulder. The results of these tests will help your doctor decide if additional testing or imaging is necessary.

Imaging tests utilized to identify a possible SLAP lesion are x-rays and magnetic resonance imaging (MRI) scan with contrast. X-rays create a clear picture of dense structures, like bones. The labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. The MRI with contrast will be able to clearly show any tear or dysfunction of the labrum.


Left: Normal Labrum, Right: SLAP Tear identified.
(MRI with contrast)

Once the dysfunction has been identified the SLAP tear is either treated with nonsurgical or surgical options. Nonsurgical options include non-steroidal anti-inflammatory medication (ie ibuprofen or naproxen) to reduce pain and swelling. Physical Therapy is another non-surgical option your doctor may provide to restore movement and strengthen your shoulder. If nonsurgical options do not improve your pain or function then surgery may be recommended to correct the labrum dysfunction. Based on the identified dysfunction, the SLAP tear is either repaired or debrided surgically.

SLAP repair vs. debridement have different rehabilitation protocols. In general, a debrided SLAP lesion is when the labrum has frayed edges and has been cleaned up (i.e. like you would cut the frayed ends off of a piece of fabric). A repaired SLAP lesion is one in which the labrum or lip, had to be tacked down to the “tee” again (i.e. like nailing down a loose shingle to your roof after a flap of it broke free in a recent storm.) A patient with a debrided labrum can be progressed much faster than one who has their labrum repaired, as there was no tissue that was surgically repaired. However, the debrided tissue may be irritated from the injury or from the surgery itself, and the patient should be progressed as tolerated. 

After a labral repair, it needs to be protected while the labrum heals. To keep your arm from moving you will most likely using a sling for 2 to 4 weeks after surgery. Once the initial pain and swelling has settled down, your doctor will start with physical therapy. The physical therapist will follow a protocol that includes gentle stretches, range of motion exercises, and eventually strengthening. Based on your rehabilitation, your doctor will discuss with you when it is safe to return to sports activity. In general, throwing athletes can return to early interval throwing 3 to 4 months after surgery.

After surgery the majority of patients report improved shoulder strength and less pain. Because patients have varied health conditions, complete recovery time is different for everyone. Although it can be a slow process, following your surgeon’s guidelines and physical therapists’ rehabilitation plan is vital to a successful outcome. Elite Sports Medicine and Physical Therapy’s therapists have experience with returning patients to their desired goals or athletes back to their sport of choice after the diagnosis of a SLAP lesion. Contact us to see how we can help you get back to the activities you love.