A SLAP tear is a torn piece of cartilage in the inner portion of the shoulder joint. It can be painful and/or limit movement in the shoulder, especially overhead motions.

The shoulder labrum is a ring of cartilage around the shoulder socket that stabilizes the head of the upper arm bone. A SLAP tear or lesion occurs when there is damage to the top of the labrum, or where the biceps tendon connects to the labrum.

SLAP is an acronym that stands for Superior (topmost) Labral tear from Anterior (front) to Posterior (back).

What is the Labrum in the Shoulder?

The shoulder is one of the most complex joints in the body; it is held together by an intricate network of tendons, ligaments and soft tissue. The labrum is a piece of cartilage that serves an important function in this network.

See Soft Tissues of the Shoulder

The labrum surrounds the edge of the glenoid, or the shoulder’s socket. The humerus head, or the top of the humerus bone in the arm, fits into the glenoid—but it is not a tight fit because the humerus head is usually larger than the glenoid socket.

See Guide to Shoulder Anatomy

The labrum lies between the humerus and the glenoid - allowing the humerus head to fit more securely into the glenoid socket. At the same time, the labrum provides cushioning and a full range of motion in the shoulder.

What is a SLAP Tear?

A SLAP tear is also referred to as a labral tear, or a tear or lesion to the labrum. This injury tends to develop over time due to repetitive movements. It can also result from acute trauma or age.

There are several types of SLAP tears:

Type I SLAP tear involves the fraying of the top rim of the labrum, but it is still attached to the glenoid. This injury is due to the aging process, and commonly found in middle-aged or older patients where symptoms may not be present. ¹ Burns JP, Bahk M, Snyder SJ. Superior labral tears: repair versus biceps tenodesis. Journal of Shoulder and Elbow Surgery. 2011; 20: S2-S8.

These tears could be treated without surgery. ² Dodson CC, Altchek DW. SLAP Lesions: An Update on Recognition and Treatment. Journal of Orthopedic & Sports Physical Therapy. 2009; 39: 71 - 80.

Type II SLAP tear is the most prevalent type of SLAP tear. In this injury, the labrum and biceps tendon detach from the top of the glenoid. Type II tears can be further categorized as anterior (at the front), posterior (at the back) or a blend of the two. Arthroscopic surgery is normally performed.
Type III SLAP tear consists of a bucket-handle tear, where the torn labrum could droop into the shoulder joint. ³ D'Alessandro DF, Fleischli JE, Connor PM. Superior Labral Lesions: Diagnosis and Management. Journal of Athletic Training. 2000; 35: 286-292. The biceps tendon remains intact. Arthroscopic surgery is often needed to remove the bucket-handle segment.
Type IV Slap tear is a bucket-handle tear to the top of the labrum, extending into the biceps tendon to varying degrees. ³ D'Alessandro DF, Fleischli JE, Connor PM. Superior Labral Lesions: Diagnosis and Management. Journal of Athletic Training. 2000; 35: 286-292. Involvement of the biceps tendon differentiates this injury from a type III SLAP tear. Treatment options could depend on the extent the biceps tendon is involved.

Labral tears can also occur in the hip, since the labrum surrounds the hip socket, but this is not referred to as a SLAP tear.

Dr. Terry Gemas is an orthopedic surgeon and the founder of Lakewood Orthopaedics and Sports Medicine in Dallas, TX. He specializes in sports medicine and has been in practice for more than 15 years. Dr. Gemas has treated professional athletes and currently serves as the head team physician for several Dallas-Forth Worth area high school, college, and club teams.