A SLAP tear is a type of shoulder injury. It affects the labrum, which is the cartilage on the rim of the shoulder’s socket. The labrum is a rubber-like tissue that holds the ball of the shoulder joint in place.
SLAP stands for “superior labrum anterior and posterior.” The tear occurs in the top (superior) area of the labrum, where the biceps tendon is attached. Specifically, the tear happens in the front (anterior) and back (posterior) of the attachment. The biceps tendon might be injured, too.
If the injury isn’t severe, it might heal with nonsurgical treatments like ice and physical therapy. If these treatments don’t work, or if the tear is serious, you’ll likely need surgery.
Though recovery time is different for everyone, it usually takes at least 4 to 6 months. Many people are then able to return to normal physical activity.
Read on to learn about the causes of SLAP tears, along with its symptoms and treatment options.
If you have a SLAP tear, you’ll likely have a wide range of symptoms. Many of these are similar to other types of shoulder injuries.
SLAP tear symptoms include:
- shoulder popping, locking, or grinding
- pain with certain movements or positions
- pain when lifting things, especially over your head
- reduced range of motion
- shoulder weakness
The causes of SLAP tear range in severity. They include:
Normal aging process
Most SLAP tears happen when the labrum wears down over time. In fact, in people over 40 years old, a labrum tear is considered to be a normal part of aging. The top part of the labrum might also fray.
SLAP injuries can be caused by physical trauma, such as:
- falling on an outstretched arm
- motor vehicle collision
- shoulder dislocation
- quickly moving the arm while it’s above the shoulder
Repetitive shoulder movements can lead to SLAP tears. This often affects:
- athletes who throw balls, like pitchers
- athletes who perform overhead motions, like weightlifters
- those who do regular physical work
SLAP injuries are classified into 10 different types. Each injury is categorized based on how the tear forms.
Originally, SLAP tears were classified into types 1 through 4. The other types, known as extended SLAP tears, were added over time. The descriptions of these types vary slightly.
Types 1 and 2
In a type 1 tear, the labrum is frayed but the biceps tendon is attached. This type of tear is degenerative and usually seen in older people.
A type 2 tear also involves a frayed labrum, but the biceps is detached. Type 2 tears are the most common SLAP injuries.
Depending on the location of the labral tear, type 2 tears are split into three categories:
- type 2A (front top)
- type 2B (back top)
- type 2C (both the front and back top)
Types 3 and 4
A type 3 tear is a bucket handle tear. This is a vertical tear where the front and back are still attached, but the center isn’t.
Type 4 is like type 3, but the tear extends into the biceps. This type of tear is associated with shoulder instability.
Types 5 and 6
In a type 5 injury, the SLAP tear extends to the front lower part of the labrum. It’s known as a Bankart lesion.
A type 6 tear is a bucket handle tear, but the “flap” is torn.
Types 7 and 8
The glenohumeral ligaments are fibrous tissues that keep the shoulder joint together. These ligaments include the superior, middle, and inferior glenohumeral ligaments.
In a type 7 tear, the injury extends into the middle and inferior glenohumeral ligaments.
Type 8 is a type 2B tear that extends into back lower part of the labrum.
Types 9 and 10
A type 9 is a type 2 tear that extends to the labrum’s circumference.
In a type 10, the injury is a type 2 tear that extends to the posteroinferior labrum.
A doctor will use several methods to diagnose your injury. These might include:
- Medical history. This helps a doctor understand what type of activity might have caused your injury.
- Physical examination. A doctor will observe your shoulder and its range of motion. They’ll also check your neck and head for any other problems.
- Imaging tests. You might get an MRI or CT scan, which lets a doctor examine the tissues in your shoulder. They may also request an X-ray if they think the bones are injured.
SLAP treatment depends on the severity and location of your injury. It usually begins with nonsurgical techniques.
Most SLAP injuries are first treated with nonsurgical methods. If your tear isn’t severe, this might be enough to heal it.
Nonsurgical treatments include home remedies such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs like ibuprofen and naproxen help relieve pain and swelling. These drugs are available over-the-counter.
- Ice. Applying ice on your shoulder will also reduce the pain. You can use a store-bought ice pack or a plastic bag filled with ice.
- Rest. Rest will allow your shoulder to heal. It’s the best way to avoid reinjuring your shoulder, which will only prolong your recovery time.
You’ll start physical therapy once your shoulder feels a bit better. A physical therapist can show you how to do specific exercises for SLAP tears.
These exercises will focus on improving the flexibility, movement, and strength of your shoulder.
If you have a severe injury, or if nonsurgical treatments don’t work, you might need surgery.
The most common method is an arthroscopy. During this procedure, a surgeon makes small cuts in your shoulder. They insert a small camera, or an arthroscope, into the joint. The surgeon then uses miniature surgical tools to repair the SLAP tear.
There are many ways to repair a tear. The best technique depends on your injury.
Examples of SLAP repairs include:
- removing the torn portion of the labrum
- trimming the tear
- stitching the tear together
- cutting out the biceps tendon attachment
With proper rehabilitation, you can expect to regain full range of motion after a SLAP tear surgery.
Recovery looks different for each person. It depends on many factors, including your:
- type of injury
- overall health
- activity level
- other shoulder problems
In general, here’s what recovery time looks like:
- 0 to 4 weeks after surgery. You’ll wear a sling to stabilize your shoulder. You will also do gentle stretches with a physical therapist.
- 5 to 7 weeks after surgery. As your shoulder heals, it might still feel somewhat painful. You may begin strengthening exercises with your physical therapist.
- 8 to 12 weeks after surgery. You’ll continue doing moves to increase your range of motion and strength. You can also start biceps strengthening exercises.
- 12 to 16 weeks after surgery. By this time, your range of motion should improve. If you’re an athlete, you can start sport-specific activity.
- 16 to 20 weeks after surgery. You can slowly increase your physical activity. Many athletes return to their sport after 6 months.
If you work a physically demanding job, you may need to miss work for most of this time. Otherwise, you might be able to return to work within a few weeks.
While there are many types of SLAP tears, most can be treated with physical therapy or surgery. The best method depends on your age, overall health, and specific injury. You’ll likely need surgery if your tear is severe.
During the recovery process, be sure to continue physical therapy and follow your doctor’s recommendations. This will help your shoulder heal and regain its normal range of function.