Shoulder labral tear (including SLAP tear)

The labrum is a rim of firm, rubbery cartilage around the edge of the shoulder socket. It deepens the socket and anchors ligaments and the biceps tendon. A labral tear can occur anywhere along the rim. A SLAP tear (superior labrum, anterior to posterior) affects the upper part of the labrum where the biceps tendon attaches, while tears at the front or lower edge are usually linked to shoulder dislocation.

• A deep, aching pain in the shoulder, often with overhead activity
• Catching, locking, popping, or grinding
• A feeling that the shoulder is unstable
• Loss of strength or range of motion
• In throwing athletes, a "dead arm" feeling or loss of throwing velocity
• Aching that disturbs sleep or flares with everyday tasks

These symptoms overlap with many other shoulder problems, so a careful examination is important.

• A fall onto an outstretched arm
• A sudden jerk on the arm, for example grabbing something heavy as it drops
• A shoulder dislocation
• Repetitive overhead motion in throwing, weightlifting, and racquet sports
• Gradual wear: fraying of the upper labrum becomes common from about middle age and is not always the cause of a person's pain

A clinician asks about the injury and activities and uses specific examination maneuvers that stress the labrum and the biceps tendon. X-rays cannot show the labrum, which is soft tissue, but they check the bones. An MRI, often an MR arthrogram in which contrast dye is injected into the joint, gives the clearest view. Some tears are confirmed only during arthroscopy.

Because labral changes on MRI are common with age, imaging findings are interpreted together with the examination.

Non-surgical care is the first step for most SLAP tears and many other labral tears. It includes rest from aggravating activities, anti-inflammatory medication when appropriate, and physical therapy to restore motion and strengthen the rotator cuff and shoulder blade muscles. Throwing athletes often work on stretching the back of the shoulder and on throwing mechanics. A steroid injection is sometimes used.

Surgery may be considered when pain and function do not improve, or when the tear is causing instability. It is usually done arthroscopically, and the options include:

• Debridement: trimming a frayed or flap-like tear
• Repair: reattaching the labrum to the bone with sutures, which is standard for labral tears linked to dislocation
• Biceps tenodesis: detaching the biceps tendon from the labrum and reattaching it lower on the upper arm bone, often considered for SLAP tears in older or less overhead-active patients or when the biceps tendon is also damaged

The surgeon chooses based on the type of tear, the patient's age and activity level, and other findings during surgery.

After surgery, a sling is usually worn for a few weeks. Physical therapy starts with gentle motion and progresses to strengthening. Throwing athletes then follow a structured interval throwing program, and return to overhead sports generally takes several months.

Strengthening the rotator cuff and shoulder blade muscles, using sound throwing mechanics, following pitch-count and rest guidelines for young throwers, and avoiding sudden jumps in overhead training can lower strain on the labrum.