Shoulder Conditions

SLAP Tears

Superior labral injuries of the shoulder

A SLAP tear is a specific injury to a cartilage ring surrounding the socket of the shoulder called the labrum. SLAP stands for Superior Labrum: Anterior to Posterior. The tear occurs in the upper (superior) portion of the labrum where one of the two bicep muscle tendons attach. It extends from the front of the bicep connection (anterior) to just behind it (posterior). SLAP tears commonly affect people who perform overhead or throwing activities, but they may also occur following an injury such as a fall, a collision during sport, or a shoulder dislocation.

Key symptoms are use-related pain, mechanical symptoms such as clicking or catching, and the arm may feel weak with overhead tasks.

What you’ll learn on this page:

1. What is the SLAP region and why is it important?

The SLAP region refers to the upper portion of the labrum.

The labrum is a ring of soft cartilage which deepens the shoulder socket
The long head of the biceps tendon attaches directly to the top of the labrum
The upper labrum and attached bicep play a minor role in keeping the shoulder centred, however studies show that there are few noticeable ill-effects when this part of the shoulder is not functioning properly or has been removed

The only real relevance of the SLAP area if it is torn is the potential to create pain

2. What causes a SLAP tear?

SLAP tears may occur due to:

In throwing and overhead athletes, repeated stress transmitted through the biceps tendon can gradually detach the labrum from the glenoid.

3. Symptoms of a SLAP tear in the shoulder

Symptoms can be variable and are often non-specific.

Common complaints include:

Because these symptoms overlap with other shoulder conditions, careful assessment is required.

Slap tears occur very frequently as we age and often are incidental findings and not an actual source of pain. Small ones exist naturally in many people and are considered natural anatomical variants.

4. How SLAP tears are diagnosed

Diagnosing a SLAP tear can be challenging, as symptoms often overlap with other shoulder conditions. A thorough clinical assessment by a shoulder specialist is essential to accurately identify the source of pain. MRI or MR arthrogram may be used to assess the labrum, however imaging alone cannot determine whether a SLAP tear is the true source of pain. Labral changes are commonly seen on MRI, particularly with ageing, and are not always symptomatic.

This diagnostic approach helps avoid inappropriate treatment, particularly unnecessary ‘SLAP repair’ surgery.

Specialist clinical examination is the most important component of diagnosis

In selected cases, a local anaesthetic injection (with or without cortisone) may be used to confirm that pain is originating from within the joint and is related to the SLAP region

5. SLAP tears with paralabral cysts

In some cases, joint fluid may leak through a SLAP tear and form a paralabral cyst. These fluid-filled cysts can enlarge over time and may cause additional symptoms by placing pressure on nearby structures.

Potential effects of a paralabral cyst include:

When a paralabral cyst is associated with persistent pain, weakness, or nerve compression, surgical management may be considered. This typically involves addressing the underlying SLAP lesion and, where appropriate, draining or removing the cyst to relieve pressure on adjacent structures.

6. Can SLAP tears be treated without surgery?

Many SLAP tears can initially be managed without surgery, particularly in people with lower functional demands.

Non-operative treatment may include:

While the labrum itself does not heal, symptoms may improve with appropriate rehabilitation.

7. When surgery may be considered for a SLAP tear

Surgery may be considered when symptoms persist despite appropriate non-operative treatment, or when SLAP pathology significantly affects function. Surgical options depend on age, activity level, tear type, and associated shoulder conditions.

Treatment options may include:

SLAP repair: In selected cases, particularly in younger or high-demand overhead athletes, the labrum may be repaired arthroscopically and reattached to the socket.
Biceps tenodesis or tenotomy: In many patients, particularly middle-aged or older individuals, addressing the biceps tendon rather than repairing the labrum may provide more reliable symptom relief. This involves releasing the biceps from its labral attachment and either reattaching it to the arm bone (tenodesis) or allowing it to settle naturally (tenotomy).

8. Individualised assessment and treatment for SLAP tears

Management of SLAP tears requires careful consideration of whether the labral tear is truly the main source of pain, or whether symptoms are related to associated conditions such as rotator cuff or biceps tendon pathology. Factors such as age, activity level, and functional goals also play an important role in guiding management.

Dr Richard Dallalana focuses on identifying the underlying cause of shoulder symptoms and tailoring treatment accordingly, rather than treating imaging findings in isolation. This approach helps ensure that management is appropriate, targeted, and aligned with each patient’s individual needs.