About the Superior Labral Tear

Many people  in the Orthopaedic community are talking about the "SLAP tear."  The SLAP tear usually occurs in people who do extensive overhead activities, like baseball pitchers.  Prior to the 1980's, the SLAP tear was barely identifiable.  Over the past 30 years we have made tremendous advances in SLAP repairs.
Symptoms include shoulder pain with overhead activity, pain in the front of the shoulder, pain with reaching above your head, pain with reaching backwards

Image of patient complaining of shoulder pain, possibly due to a SLAP ter.

What is a SLAP tear?

A SLAP tear is a tear of the cartilage (labrum) surrounding the bony glenoid.  The tear occurs because one part of the biceps tendon originates (starts) at the top of the glenoid (shoulder socket) from the labrum.  With repetitive pulling of the biceps tendon, the labrum may "peel off" the top of the glenoid bone and cause pain.
Continued pain is usually caused because the biceps tendon continues to pull on the torn superior labrum (see image) and therefore the superior labrum is never able to seat properly and heal.

Arthroscopic image of a SLAP tear. Notice how the superior labrum is peeled off the top of the glenoid and a gap is created. This is a Type 2 SLAP tear that will require repair.

Normal Anatomy vs SLAP tear

Normal anatomy of a shoulder. Notice how the biceps tendon comes off the top part of the labrum.

Here the SLAP (Superior tear anterior to posterior) tear is seen. The biceps tendon has pulled the labral tissue off the top of the labrum. This is a SLAP tear.

Types of Tear

There are multiple variants of SLAP (superior labral anterior to posterior) tear. Image A shows fraying of the labrum consistent with a Type 1 tear. Image B shows a Type 2 tear, which is the one most commonly seen. Image C shows a Type 3 tear where there is a bucket handle tear of the superior labrum. Image D shows a tear of the superior labrum AND the biceps.

SLAP Repair

Rehabilitation

Depending on the repair and tissue quality, most people report being back to 100% around 4-6 months after surgery.  The rehabilitation process is long, starting with simple motion and progressing to strengthening activities.  Most patients start physical therapy around 4-6 weeks after surgery.  Outcomes are extremely good, with success rates greater than 95%!