SLAP stands for Superior Labrum Anterior to Posterior. It is a tear of the top (superior) part of the labrum, the cartilage rim around the shoulder socket. The tear runs from front (anterior) to back (posterior), which is where the name comes from. The top of the labrum is also where the long head of the biceps tendon anchors into the joint, so SLAP tears often involve the biceps anchor and can cause biceps-related pain at the front of the shoulder.

How is a SLAP tear different from a Bankart tear?

Both are labral tears but they involve different parts of the labrum. A Bankart tear is a tear of the front (anterior-inferior) labrum, almost always caused by a dislocation of the shoulder. A SLAP tear is a tear of the top (superior) labrum, often caused by overhead activity or a fall on an outstretched arm rather than dislocation. They have different mechanisms, different symptoms, and different surgical treatments.

What does a SLAP tear feel like?

The most common symptoms are deep aching pain in the front or top of the shoulder, clicking or popping with movement, and pain with overhead activity. Throwing athletes often report a loss of throwing velocity or accuracy and a sense of the arm being "dead" after throwing. Pain may be worse at night, particularly lying on the affected side. Many SLAP tears, especially degenerative ones, cause minimal symptoms and are found incidentally on MRI scans done for other reasons.

Do all SLAP tears need surgery?

No. Many SLAP tears settle with non-operative treatment: activity modification, physiotherapy focused on the rotator cuff and scapular stabilisers, anti-inflammatories, and sometimes a corticosteroid injection. Surgery is reserved for tears that remain painful and limit function after a fair trial of non-operative treatment, or for high-demand throwers who need full labral integrity for sport. The decision is individual and depends on age, activity profile, and the imaging findings.

What surgery is done for a SLAP tear?

There are two main operations: SLAP repair (re-attaching the torn labrum to the bone with suture anchors, preserving the biceps anchor) and biceps tenodesis (releasing the biceps tendon from the labrum and re-anchoring it lower on the humerus, which removes the painful tension on the labral attachment). SLAP repair is traditionally used in younger athletes who need the biceps anchor preserved. Biceps tenodesis has become the preferred operation for patients over around 35 to 40 and for those with biceps-tendon-related symptoms, because the outcomes are more predictable in that group.

How long is recovery from SLAP surgery?

After SLAP repair, a sling is worn for four to six weeks while the labrum heals back to the bone. Passive range of motion starts within the first week or two. Active range progresses through weeks four to twelve, with strengthening from around three months. Return to overhead activity is typically three to six months, and return to throwing sport six to nine months. After biceps tenodesis, the sling time is shorter (around four weeks) and the recovery is generally faster because the labrum itself does not need to heal.

Condition

SLAP tear

A SLAP tear (Superior Labrum Anterior to Posterior tear) is a tear of the top of the labrum, the cartilage rim around the shoulder socket. The top of the labrum is where the long head of the biceps tendon anchors into the joint, so SLAP tears often involve biceps-related pain at the front and top of the shoulder.

Anatomy

The labrum and the biceps anchor

The labrum is a rim of fibrocartilage that runs around the edge of the glenoid (the shoulder socket). It deepens the socket, increases the contact area with the humeral head, and acts as an attachment point for the ligaments that stabilise the joint.

The long head of the biceps tendon runs through the front of the shoulder and curves over the top of the humeral head to anchor into the top (superior) part of the labrum. This combined structure of the biceps tendon, biceps anchor, and superior labrum is sometimes called the labral-bicipital complex.

A SLAP tear is a tear of this superior labrum, running from front (anterior) to back (posterior). Different patterns of SLAP tear are classified by where exactly the tear sits and how much of the biceps anchor is involved. The most common pattern (Type II) involves detachment of the biceps anchor from the bone.

For more on the wider anatomy of the shoulder, see the shoulder anatomy reference page.

How SLAP tears happen

Acute injury, repetitive use, or age

SLAP tears typically happen in one of three ways:

Acute injury. A fall onto an outstretched arm, a sudden heavy lift, or forceful traction on the arm (for example, catching a falling object). The force at the biceps anchor levers the labrum off the bone.
Repetitive overhead activity. Throwing athletes, swimmers, racquet-sport players, and manual workers with repeated overhead loading can develop SLAP tears over time. The throwing motion in particular generates enormous twisting forces at the biceps anchor.
Age-related degeneration. The superior labrum thins and frays with age. By around 40, a degree of superior labral fraying is common on MRI and often asymptomatic. A tear identified on imaging is not by itself a reason for treatment if it is not causing symptoms.

Symptoms

What a SLAP tear feels like

The classic symptoms of a SLAP tear include:

Deep aching pain at the front or top of the shoulder, often hard to point to with a single finger.
Clicking, catching, or popping with shoulder movement, particularly when the arm is raised overhead or rotated.
Pain with overhead activity or with lifting weights, particularly with bench press or any movement that loads the biceps.
Loss of throwing velocity or accuracy in throwing athletes, sometimes described as a "dead arm" feeling after throwing.
Night pain, particularly when lying on the affected side.
Bicipital pain with the elbow at 90 degrees and the forearm supinated (palm up), where loading the biceps reproduces the pain.

SLAP tears often coexist with other shoulder problems such as rotator cuff tears, biceps tendinopathy, and shoulder impingement. A careful assessment is needed to identify which of these structures is the dominant source of pain.

Diagnosis

How a SLAP tear is diagnosed

Diagnosis is based on the history, examination, and imaging, with arthroscopy as the definitive test.

History. Mechanism of injury, sport or work demands, throwing patterns, and pattern of pain.
Examination. Several physical tests are used to provoke SLAP-related pain, including O'Brien's active compression test, the biceps load test, and the dynamic labral shear test. None is perfectly reliable in isolation; the pattern across multiple tests is more informative than any single test.
Plain x-rays. Useful to rule out arthritis, fracture, or bony lesions. Plain x-rays cannot show the labrum.
MRI scan (with contrast). MRI with an intra-articular contrast injection (MR arthrogram) is the most reliable imaging test for SLAP tears. A plain MRI without contrast has lower sensitivity and can miss smaller tears.
Arthroscopy. Direct visualisation at the time of arthroscopic surgery is the definitive way to confirm a SLAP tear and to classify its pattern.

A key point in interpretation: SLAP findings on MRI do not always cause symptoms. A SLAP tear seen on MRI in a 50-year-old with no shoulder pain may be an incidental degenerative finding rather than a problem to treat. Imaging should always be interpreted in the context of the clinical picture.

Treatment

Non-operative and surgical options

Many SLAP tears can be managed without surgery, particularly degenerative tears in older patients and acute tears with only mild symptoms.

Activity modification. Avoiding provocative positions (heavy overhead lifting, bench press, throwing) for a period of weeks to months.
Physiotherapy. Targeted at the rotator cuff, scapular stabilisers, and posterior capsule stretching. In throwing athletes, addressing any deficit in shoulder internal rotation is important.
Anti-inflammatories. A short course of oral NSAIDs can help with the inflammatory component.
Corticosteroid injection. Selected cases, particularly where there is concurrent biceps tendinopathy or bursitis. Useful both for symptom control and as a diagnostic test (a response to injection supports the diagnosis).

Surgery is considered when symptoms persist despite a fair trial of non-operative treatment, or in younger, high-demand athletes where the underlying anatomy needs to be restored. Two main operations are available.

SLAP repair. Arthroscopic re-attachment of the torn superior labrum to the bone with suture anchors. Preserves the biceps anchor. Traditionally the operation of choice for younger athletes with a Type II SLAP tear who need full labral integrity for overhead sport.
Biceps tenodesis. Arthroscopic release of the long head of the biceps from its labral anchor, followed by re-attachment of the tendon lower down on the humerus. Removes the painful traction on the labral attachment without trying to repair the labrum itself. Increasingly preferred for patients over around 35 to 40 and for those with biceps-tendon-related symptoms, because the outcomes are more predictable in that group.
Biceps tenotomy. Simple release of the long head of the biceps from the labrum, without re-attachment. Quickest recovery, but carries a small risk of a visible "Popeye" deformity in the upper arm and a mild loss of supination strength. Reserved for older, lower-demand patients who prioritise quick recovery over cosmetic appearance and strength.

The choice between these operations is individual and depends on age, activity profile, biceps tendon condition, and patient preference. Dr Piper will discuss the relevant options at the time of consultation.

Recovery

What to expect after surgery

Recovery depends on which operation is performed. SLAP repair has a slower recovery because the labrum needs to heal back to bone; biceps tenodesis recovers faster because the labrum itself is not being repaired.

After SLAP repair: A sling is worn for four to six weeks. Passive range of motion starts within the first week or two under physiotherapy guidance. Active movement progresses through weeks four to twelve. Strengthening starts from around three months. Most patients can drive at six weeks once out of the sling and with safe two-handed control of the steering wheel. Return to non-contact overhead activity is typically three to four months. Return to throwing sport is usually six to nine months.

After biceps tenodesis: A sling is worn for around four weeks. Active range progresses from week four. Strengthening starts from around six weeks. Driving usually at four to six weeks once out of the sling and with safe two-handed control of the steering wheel. Return to overhead activity is typically two to three months. Return to full activity including contact sport is usually three to four months.

Risks

Risks of surgery for a SLAP tear

As with any surgery, there are risks. The specific risks vary with which operation is performed. The general risks include (but are not limited to):

Stiffness. A period of stiffness after sling removal is normal and improves with physiotherapy. A small number of patients develop significant stiffness that needs further treatment (frozen shoulder).
Frozen shoulder. A specific condition that causes pain and stiffness in the shoulder. The condition is self-limited (gets better by itself) but recovery from frozen shoulder can take 12 to 18 months or more.
Persistent pain. Some patients have ongoing pain after SLAP surgery, particularly throwing athletes for whom return to pre-injury level is less predictable.
Re-tear or failure of repair. A repaired labrum is never as strong as an undamaged labrum. Re-tear rates are higher in younger throwing athletes.
Biceps-specific issues. After biceps tenodesis: failure of the fixation, fracture at the anchor site (uncommon). After biceps tenotomy: a visible "Popeye" deformity of the upper arm in around 10 percent of patients, and a mild reduction in supination strength.
Infection. Very rare with arthroscopic shoulder surgery. Antibiotics are given at induction.
Nerve injury. Rare. Stretch injuries to the brachial plexus from positioning are uncommon and usually recover.
Complex regional pain syndrome (CRPS). A rare condition that causes pain and stiffness in the hand.
Anaesthetic complications. Discussed separately with the anaesthetist before surgery.
DVT. Very rare with surgery of the upper limb.

FAQ

Frequently asked questions

What is a SLAP tear?: SLAP stands for Superior Labrum Anterior to Posterior. It is a tear of the top (superior) part of the labrum, the cartilage rim around the shoulder socket. The tear runs from front (anterior) to back (posterior), which is where the name comes from. The top of the labrum is also where the long head of the biceps tendon anchors into the joint, so SLAP tears often involve the biceps anchor and can cause biceps-related pain at the front of the shoulder.
How is a SLAP tear different from a Bankart tear?: Both are labral tears but they involve different parts of the labrum. A Bankart tear is a tear of the front (anterior-inferior) labrum, almost always caused by a dislocation of the shoulder. A SLAP tear is a tear of the top (superior) labrum, often caused by overhead activity or a fall on an outstretched arm rather than dislocation. They have different mechanisms, different symptoms, and different surgical treatments.
What does a SLAP tear feel like?: The most common symptoms are deep aching pain in the front or top of the shoulder, clicking or popping with movement, and pain with overhead activity. Throwing athletes often report a loss of throwing velocity or accuracy and a sense of the arm being "dead" after throwing. Pain may be worse at night, particularly lying on the affected side. Many SLAP tears, especially degenerative ones, cause minimal symptoms and are found incidentally on MRI scans done for other reasons.
Do all SLAP tears need surgery?: No. Many SLAP tears settle with non-operative treatment: activity modification, physiotherapy focused on the rotator cuff and scapular stabilisers, anti-inflammatories, and sometimes a corticosteroid injection. Surgery is reserved for tears that remain painful and limit function after a fair trial of non-operative treatment, or for high-demand throwers who need full labral integrity for sport. The decision is individual and depends on age, activity profile, and the imaging findings.
What surgery is done for a SLAP tear?: There are two main operations: SLAP repair (re-attaching the torn labrum to the bone with suture anchors, preserving the biceps anchor) and biceps tenodesis (releasing the biceps tendon from the labrum and re-anchoring it lower on the humerus, which removes the painful tension on the labral attachment). SLAP repair is traditionally used in younger athletes who need the biceps anchor preserved. Biceps tenodesis has become the preferred operation for patients over around 35 to 40 and for those with biceps-tendon-related symptoms, because the outcomes are more predictable in that group.
How long is recovery from SLAP surgery?: After SLAP repair, a sling is worn for four to six weeks while the labrum heals back to the bone. Passive range of motion starts within the first week or two. Active range progresses through weeks four to twelve, with strengthening from around three months. Return to overhead activity is typically three to six months, and return to throwing sport six to nine months. After biceps tenodesis, the sling time is shorter (around four weeks) and the recovery is generally faster because the labrum itself does not need to heal.

References

Related on this site

Related conditions and procedures

Shoulder pain or clicking?

Book a consultation with Dr Piper

Bring a GP referral and any imaging you have (x-rays, MRI, or MR arthrogram). Consultations at Lakeview Private Hospital, Norwest.

Book Appointment All conditions