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Superior Labrum Anterior Posterior Tears, also known as SLAP tears/ lesions, are an injury to the labrum of the shoulder. 


The shoulder is an incredibly mobile ball and socket joint which uses a complex array of ligaments, tendons, and cartilage to contribute to the joint’s stability. 

The three bones which make up this joint are the:

  • Scapula (shoulder blade) 
  • Humerus (upper arm bone)
  • Clavicle (collarbone)

The head of the humerus (ball) fits into the round concave groove of the scapula (socket) which is covered by a thick layer of cup-shaped cartilage known as the glenoid labrum. The labrum lines the shoulder joint to secure the humerus and both deepen and reinforce the socket. The labrum also serves as an attachment point for many tendons such as the rotator cuff muscles and the biceps tendon. 

What are SLAP Tears?

During a SLAP tear, the superior (top) part of the shoulder joint is injured. This is typically where the biceps tendon runs along to attach to the anterior (front) and posterior (back) part of the labrum. As such, injuries to the top of the labrum are often seen in combination with injuries to the biceps tendon as well as the surrounding ligaments.


SLAP tears can be caused by both traumatic and non-traumatic mechanisms.

Some examples of acute traumatic causes include:

  • Motor vehicle accidents
  • Fall onto an outstretched hand
  • Forceful pulling on the arm
  • Shoulder Dislocation
  • Forceful overhead movements

Some examples of non-traumatic causes include:

  • Repetitive overhead movements ie. repetitive throwing
  • Age-related wear and tear

Who do they most commonly affect?

Based on the nature of the injury, SLAP tears are often seen in throwing athletes (ie. tennis players), weightlifters, and factory workers.

SLAP tears may also develop overtime with repetitive shoulder movement. As such, they are commonly observed in individuals over the age of 40 as a normal part of age-related change.

Signs and Symptoms

Common signs and symptoms may include:

  • Constant, deep, dull ache in the shoulder
  • Pain with reaching back or with overhead movements
  • Painful popping, clicking or grinding with shoulder movement
  • Decrease in shoulder strength
  • Decrease in shoulder movement
  • Difficulty and/or increase in pain with throwing
  • Inability to lie on the affected shoulder

The location of the pain may be quite diffuse and difficult to point to. However, pain is most commonly felt over the front of the shoulder or just over the outside of the shoulder if the biceps tendon is involved.


SLAP tears may be diagnosed through:

  • Subjective Examination:
    • Discussing symptoms, onset of pain, aggravating factors and any previous shoulder injuries
  • Physical Examination:
    • A thorough hands-on assessment evaluating shoulder range of motion, strength, stability, and response to special orthopaedic tests.
  • Magnetic Resonance Imaging (MRI) or MR Arthrogram:
    • The gold standard imaging technique for SLAP tear diagnosis

Evidence indicates that a combination of both imaging and clinical testing is required for the greatest diagnostic accuracy.

Management Options

The management of SLAP tears varies vastly based on the amount and type of injury. However, the majority of SLAP tears are initially managed non-operatively.

During the acute stage, the management of all SLAP tears should focus on reducing inflammation and managing pain. This may be through rest, cryotherapy/ ice-pack application, non-steroidal anti-inflammatory (NSAID) medications and activity modification. Occasionally, injections for pain relief may also be indicated.


Physiotherapy has been shown to be successful in the management of SLAP tears with high rates of athletes being able to return to play post rehabilitation.

Physiotherapy will help you to gradually improve shoulder movement, strength and stability and address any predisposing issues in shoulder biomechanics. This may be through focusing on postural correction via exercise, bracing and taping as well as a comprehensive rotator cuff rehabilitation program to help maximise your function and return to pre-injury capacity.

Following consistent rehabilitation, a full recovery may take up to 3 to 4 months.


In cases where pain and symptoms persist and limit your ability to engage in activities of daily life, then surgical options may be considered if all non-operative treatment options have been exhausted. The type of surgery will be dependent on the type and severity of SLAP injury.

Rehabilitation after surgery will be dependent on the type of surgery and the preferences of the surgeon. Management will usually comprise of a period of sling immobilisation and rest, followed by a gradual re-introduction of movement and progressive strengthening exercises.

Recovery times will vary from person to person, typically ranging from 3 to 12 months.

Prognosis/ Outlook

Overall, good outcomes have been demonstrated with both non-operative and operative management. Following treatment, evidence has demonstrated a return to sport rate of 93%, with 72% of individuals able to participate and compete at their pre-injury level of sport after recovering from a SLAP injury.

Risk of Re-Injury

Recurring SLAP tears are common where injuries have been inadequately managed and the individual has recommenced the physical activity that contributed to the initial injury. As such, engaging in a comprehensive rehabilitation program is crucial post injury.

Other strategies to reduce the risk of re-injury include:

  • Warming up prior to engaging in physical activity
  • Avoiding repetitive overhead movements
  • Maintaining shoulder strength and conditioning
  • Completing a regular shoulder stretching and mobility routine
  • Wearing a supportive brace
  • Allowing sufficient time for rest and recovery between competitions or intense training sessions
  • Seeking support from your doctor or physiotherapist should persistent shoulder pain arise


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Freijomil, N., Peters, S., Millay, A., Sinda, T., Sunset, J., & Reiman, M. P. (2020). The success of return to sport after superior labrum anterior to posterior (slap) tears: A systematic review and meta-analysis. International Journal of Sports Physical Therapy, 15(5), 659–670. https://doi.org/10.26603/ijspt20200659

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Steinmetz, R. G., Guth, J. J., Matava, M. J., Brophy, R. H., & Smith, M. V. (2022). Return to play following nonsurgical management of superior labrum anterior-posterior tears: A systematic review. Journal of Shoulder and Elbow Surgery, 31(6), 1323–1333. https://doi.org/10.1016/j.jse.2021.12.022

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