Labrum SLAP Tear Treatment
SLAP stands for superior labrum anterior to posterior, describing a tear running front to back across the top of the shoulder socket, right where the biceps tendon anchors into the labrum. It is the classic injury of the thrower, the swimmer, the volleyball player, and the tennis player, and it is also one of the most frequently misdiagnosed problems in the shoulder.
Overhead athletes are the population Steven Struhl, MD has spent his career around. He serves as a medical consultant to the United States Open tennis tournament and as medical director for Sportscare Physical Therapy, the practice that treats the Brooklyn Nets, and he completed his sports medicine fellowship at Penn State University. He is board certified in orthopedic surgery and separately in sports medicine, is a member of the Arthroscopy Association of North America, and treats superior labral injuries at his Manhattan and White Plains offices.
What Is a SLAP Tear?
The superior labrum is where the long head of the biceps tendon attaches, so a tear here does not simply affect the socket rim, it destabilizes the biceps anchor as well. That connection is why SLAP tears produce pain deep in the shoulder that patients describe as being inside the joint rather than on the surface, and why biceps treatment becomes part of the surgical conversation.
- Overhead Repetition: cumulative stress from throwing, serving, or swimming strokes over seasons.
- Traction Injury: a sudden pull on the arm, such as catching a falling object or a heavy bag.
- Compression Injury: falling onto an outstretched arm, driving the ball up into the labrum.
- Age Related Change: fraying at the biceps anchor that occurs commonly after age forty.
SLAP Tear Symptoms in Throwing Athletes
- Loss Of Velocity: throwers lose speed and accuracy before pain becomes the main complaint.
- Deep Joint Pain: discomfort felt inside the shoulder rather than at a point on the surface.
- Pain In The Cocking Phase: symptoms concentrated at maximum external rotation before release.
- Catching Sensation: clicking or locking during specific overhead positions.
The velocity loss deserves emphasis, because athletes routinely attribute a declining arm to fatigue or mechanics and continue through a season with a structural injury that is quietly getting worse.
SLAP Tear Treatment, Repair, and Biceps Tenodesis
Age changes the calculus here more than with most shoulder injuries. Fraying at the biceps anchor is a normal finding in middle aged shoulders, and repairing it aggressively in a patient over forty tends to produce stiffness without benefit. In a young throwing athlete, the same lesion may need repair.
- Rehabilitation First: most patients begin with a program addressing the cuff, scapula, and mechanics.
- SLAP Repair: the torn superior labrum is reattached with anchors, favored in younger athletes.
- Biceps Tenodesis: the biceps tendon is released and reattached lower, often preferred over age forty.
- Debridement: frayed tissue is smoothed when the tear is not structurally repairable.
“By using high quality imaging modalities such as MRI early in the treatment process, we get to the heart of the problem quickly and precisely.” – Steven Struhl, MD, Board Certified Orthopedic and Sports Medicine Surgeon
Frequently Asked Questions About SLAP Tears
- A tear of the superior labrum extending from front to back across the top of the shoulder socket, at the point where the biceps tendon anchors. The name is an acronym for superior labrum anterior to posterior, describing the location and direction of the tear rather than its severity.
- The throwing motion places enormous rotational force on the shoulder at maximum external rotation, and the biceps anchor absorbs a peeling stress at that instant. Repeated thousands of times across seasons, that stress can strip the labrum from its attachment at the top of the socket.
- Often, yes. Many patients improve substantially with rehabilitation addressing rotator cuff strength, shoulder blade control, and throwing mechanics, and a meaningful number of degenerative superior labral changes never require surgical treatment at all.
- In patients over roughly forty, repairing the superior labrum frequently produces stiffness and persistent pain, while moving the biceps attachment to a lower position on the arm bone reliably relieves symptoms. The choice depends on age, activity level, and what the tissue actually looks like at surgery.
- Many athletes return to their prior level, though SLAP injuries have a more variable return to throwing than most shoulder procedures, and elite throwers in particular deserve that conversation frankly before surgery rather than after.
- Physical examination tests that load the biceps anchor provide the initial suspicion, and confirmation generally requires MRI with contrast injected into the joint, since a superior labral tear is difficult to see reliably on a standard MRI.
Why Athletes Choose Dr. Struhl for SLAP Tear Care
- Sports Medicine Fellowship: subspecialty training at Penn State University in athletic injury.
- US Open Consultant: medical consultant to the United States Open tennis tournament.
- Brooklyn Nets Affiliation: medical director for Sportscare Physical Therapy.
- Age Appropriate Surgery: repair or tenodesis chosen by the evidence rather than by habit.
Schedule a SLAP Tear Evaluation in New York City
An arm that has lost velocity and aches deep in the joint at the top of the throwing motion is describing a specific injury, and the evaluation for it is specific too. Dr. Struhl evaluates superior labral injuries at his Manhattan and White Plains offices and reviews outside imaging for athletes traveling from outside the region. Call the New York City office at (212) 207-1990 or the Westchester office at (914) 328-4111 to schedule an appointment.
