- Site
- Superior labrum + biceps anchor
- Common in
- Overhead athletes, manual workers
- First-line
- Physiotherapy 3–6 months
- Surgical
- Biceps tenodesis (more common) or SLAP repair (selected)
What a SLAP tear is.
SLAP is an acronym for Superior Labrum Anterior to Posterior. The labrum is a fibrocartilage rim around the glenoid socket; the long head of biceps tendon attaches directly into the superior labrum. A SLAP tear is an injury at this attachment point. The Snyder classification describes four basic types, with the most common being a fraying of the superior labrum (Type I) or a detachment of the biceps anchor (Type II).
Who develops them.
Two patient groups predominate:
- Overhead athletes — pitchers, swimmers, tennis players, javelin throwers. The repetitive peel-back forces during late cocking are thought to detach the biceps anchor.
- Adults over 40 — many SLAP findings on MRI in this age group are degenerative rather than traumatic, and the diagnosis must be interpreted carefully alongside the clinical picture.
How the diagnosis is made.
SLAP tears are notoriously difficult to diagnose clinically. No examination test is reliably sensitive or specific. The clinician relies on a combination of provocative tests (O'Brien, biceps load II, Speed's, dynamic labral shear), MRI (preferably with intra-articular contrast — MR arthrogram), and sometimes a diagnostic injection of local anaesthetic into the joint. Many MRI-diagnosed SLAP findings represent age-appropriate labral change and are not the source of symptoms.
The shift in management.
Ten years ago, symptomatic SLAP tears were routinely repaired arthroscopically. The contemporary evidence has shifted considerably — SLAP repair, particularly in patients over 35, has unpredictable results and a high revision rate. In most patients, the modern approach is:
- 3–6 months of structured physiotherapy as the first-line treatment.
- Image-guided corticosteroid injection into the bicipital groove or glenohumeral joint for symptom control.
- Surgery, when it is required, is increasingly biceps tenodesis — detaching the painful biceps anchor and re-attaching the tendon to the upper humerus. This reliably eliminates the pain source and avoids the unpredictability of SLAP repair.
SLAP repair is reserved for younger patients (typically under 35), particularly throwing athletes, in whom preserving the native biceps anchor function is important.
Frequently asked questions.
I have a SLAP tear on MRI — do I need surgery?
Often not. Many SLAP findings on MRI in adults over 40 are degenerative rather than symptomatic. A trial of 3–6 months of physiotherapy is the appropriate first step.
When is biceps tenodesis used instead of SLAP repair?
In patients over the age of 35, the published evidence shows higher rates of post-operative stiffness and revision after SLAP repair than after biceps tenodesis. Tenodesis addresses the painful biceps anchor as the symptom source and is used selectively in this age group.
I'm a 22-year-old pitcher with a SLAP tear — what's the plan?
Younger throwing athletes are different. SLAP repair (or selective non-operative management with sport-specific rehab) is preferred in this group to preserve the function of the native biceps anchor.
Will I lose strength after biceps tenodesis?
No detectable loss of elbow flexion or supination strength in most studies. The cosmetic contour is preserved.
How long does recovery take?
Sling for 3 weeks. Return to driving at approximately 3 weeks. Light strength training at 8 weeks. Full sport at 4–6 months.
References.
- Snyder SJ, et al. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–279.
- Provencher MT, et al. A prospective analysis of 179 type 2 SLAP repairs. Am J Sports Med. 2013;41(4):880–886.
- Boileau P, et al. Arthroscopic biceps tenodesis or SLAP repair in patients over 50. J Shoulder Elbow Surg. 2009;18(2):247–253.