Shoulder Labral Tear (SLAP Tear): Symptoms, Treatment and Recovery

01Anatomy

What the labrum does

The shoulder is a ball-and-socket joint with a very shallow socket, the glenoid. The labrum is a rim of fibrocartilage around the socket that makes it deeper, helps keep the ball centred and acts as an attachment point for the ligaments and for the long head of the biceps tendon at the top.

Because the shoulder relies on soft tissues for stability, a labral tear can make it feel weak or loose, especially during overhead or throwing movements.

02Types

Types of labral tear

• SLAP tear: superior labrum, anterior to posterior. A tear at the top of the socket where the biceps attaches. Common in throwers, after falls on an outstretched arm and with age-related wear.
• Bankart tear: at the front and bottom of the socket, usually caused by a shoulder dislocation. It often leads to repeated dislocations in young people; see the NHS guidance on a dislocated shoulder.
• Posterior tear: at the back of the socket, seen in weightlifters, rugby players and after posterior dislocation.
• Degenerative fraying: common after 40 and often found on scans in people without symptoms.

03Symptoms

Symptoms of a labral tear

• A deep ache inside the shoulder, hard to pinpoint.
• Pain with overhead activities, throwing or reaching behind.
• Clicking, popping, catching or locking during movement.
• A feeling that the shoulder is loose, unstable or might slip out.
• Loss of strength and reduced throwing speed.
• Pain at night or when lying on the affected side.

Many of these symptoms overlap with rotator cuff problems and impingement, which is why an examination is needed.

04Causes

How labral tears happen

• A fall onto an outstretched arm or directly onto the shoulder.
• A shoulder dislocation or partial dislocation.
• Repetitive overhead activity, as in baseball, handball, tennis, swimming or volleyball.
• A sudden pull on the arm, such as catching a heavy object or being pulled.
• Lifting heavy weights overhead.
• Gradual wear with age.

05Diagnosis

How it is diagnosed

A doctor or physiotherapist asks how the problem started and tests the shoulder’s movement, strength and stability, including specific tests for the labrum and biceps. No single test is definitive.

An MRI, often with contrast injected into the joint (MR arthrogram), shows the labrum best. Because labral fraying is common on scans in people without pain, the scan is always interpreted together with the symptoms and examination.

06Physiotherapy

Physiotherapy for a labral tear

• Settling pain with activity modification, ice or heat and appropriate pain relief.
• Restoring range of motion, especially internal rotation if the back of the shoulder is tight.
• Strengthening the rotator cuff; see rotator cuff exercises.
• Strengthening and control of the shoulder blade muscles.
• Gradual return to overhead and sport-specific movements, including throwing programmes.
• Core and leg strength, which reduce the load on the shoulder when throwing.

A course of 3 to 6 months of structured rehabilitation is usually tried before considering surgery for SLAP tears. See also shoulder mobility exercises.

07Surgery

When surgery is needed

Surgery is considered for young people with a Bankart tear and repeated dislocations, for athletes whose instability prevents them from playing, and for SLAP tears that remain painful after good rehabilitation. It is usually done by keyhole surgery (arthroscopy).

Options include repairing the labrum back to the bone with small anchors or, in older patients with SLAP tears, releasing the biceps tendon from the labrum and reattaching it lower down (biceps tenodesis), which often gives more reliable pain relief.

08Recovery

Recovery time

• Non-surgical treatment: improvement is usually seen over 6 to 12 weeks, with full rehabilitation over 3 to 6 months.
• After repair: a sling for about 4 to 6 weeks, then gradual exercises.
• Return to daily activities: usually within 2 to 3 months.
• Return to contact or overhead sport: often 4 to 6 months, and up to 9 to 12 months for throwing athletes.

09Summary

Key points to remember

• The labrum deepens the shoulder socket and anchors the biceps tendon.
• SLAP tears affect the top of the labrum; Bankart tears follow dislocations.
• Many tears improve with targeted physiotherapy.
• Surgery is mainly for recurrent instability or persistent symptoms.