Shoulder Labral Tears in Tennis Players: What You Should Know About Diagnosis, Treatment, and Getting Back on the Court

By: Christopher S. Raffo, MD • Fellowship-Trained Sports Medicine Orthopedic Surgeon

Shoulder labral tears are one of the most common causes of pain and lost performance I see in tennis players, partic

ularly those who serve and hit overhead with high volume and intensity. The good news is that with early recognition, the right treatment approach, and proper rehabilitation, most players can return to competitive play. In this post, I want to walk you through what a labral tear is, how it develops in tennis, and what your treatment options look like—including the important choice between SLAP repair and biceps tenodesis.

What Is a Labral Tear?

The shoulder labrum is a ring of specialized cartilage that surrounds and deepens the socket (the glenoid), helping to keep the ball of the upper arm bone (the humerus) centered during motion.1 In tennis, repetitive overhead serves and smashes generate significant rotational forces across this cartilage and the biceps tendon that attaches to it, making the labrum particularly vulnerable to injury over time.

The most common pattern of labral injury in overhead athletes is called a SLAP tear (Superior Labrum Anterior to Posterior). This involves the top portion of the labrum, right where the long head of the biceps tendon anchors into the socket.3 Because the shoulder is the most mobile—and least inherently stable—joint in the body, even small disruptions to the labrum can meaningfully affect your stability, racquet control, and power on the court. Left untreated, these injuries often lead to compensatory mechanics that place additional stress on the rotator cuff and other structures.

How Do Labral Tears Develop in Tennis Players?

SLAP tears in tennis players typically develop during the early acceleration phase of the serve, when the shoulder is in a position of maximum abduction and external rotation. In this position, the biceps-labrum complex is subjected to what we call a “peel-back” force, which gradually lifts the labrum away from the rim of the socket.2 Repetitive microtrauma in this position—compounded by years of overhead play—can cause progressive labral detachment, especially in players who have developed a loss of internal rotation in the shoulder known as glenohumeral internal rotation deficit (GIRD).4

Sudden traumatic events, such as a fall onto an outstretched arm or a forceful overhead smash, can also cause acute labral tears. In my experience, however, most tennis players develop these injuries gradually. You might first notice pain only during serves, then eventually during routine groundstrokes and daily activities. Without treatment, many players unconsciously reduce serve velocity, alter their toss, or change their swing mechanics—which places additional stress on other parts of the body.6,16

Symptoms and Diagnosis

Common symptoms of a SLAP tear in tennis players include deep, poorly localized shoulder pain, mechanical catching or popping, and a vague sense of weakness or “dead arm” during overhead motion.3 You may notice difficulty generating your usual power and accuracy on the serve, or a grinding sensation during shoulder movement. Some players also experience a measurable loss of internal rotation, which is closely linked to GIRD and an increased risk of SLAP injury.4

Diagnosis begins with a thorough history that focuses on when and how the pain started, your stroke mechanics, training volume, and any prior shoulder problems. This is followed by a detailed shoulder and scapular examination, including specialized provocative tests, assessment of range of motion and strength, and evaluation of scapular stability and control. Advanced imaging—typically an MRI with intra-articular contrast (an MR arthrogram)—is used to confirm the presence and pattern of labral tearing and to identify any associated injuries, such as rotator cuff pathology.3

Non-Surgical Treatment

Many tennis players with labral tears improve significantly with a structured non-operative program, particularly when symptoms are caught early. Current evidence supports an initial trial of three to six months of focused rehabilitation before considering surgery.5 Management centers on relative rest from aggravating activities, anti-inflammatory measures, and a targeted rehabilitation program emphasizing scapular control, rotator cuff strengthening, and restoration of internal rotation and total arc of motion. Correcting GIRD through posterior capsule stretching and soft-tissue work is a critical component of both prevention and treatment in overhead athletes.4

A skilled physical therapist who understands overhead sports will also evaluate and address kinetic-chain deficits involving the trunk, hips, and lower extremities, because problems anywhere along this chain can contribute to shoulder overload.6,17 When pain persists despite optimized rehabilitation, or when mechanical symptoms and functional limitations remain significant in a competitive player, surgical options are considered to restore stability and support a durable return to sport.

Surgical Options: SLAP Repair vs. Biceps Tenodesis

When surgery is indicated, the two primary options for a type II SLAP lesion are arthroscopic SLAP repair and biceps tenodesis. Understanding the differences between these procedures will help you have a more informed conversation with your surgeon about what is right for your shoulder.

SLAP repair involves reattaching the torn superior labrum back to the socket rim using small suture anchors. Historically, this was the standard approach, and it can provide meaningful pain relief and functional improvement. However, subsequent studies have shown that return to the pre-injury level of play can be unpredictable, and some patients experience postoperative stiffness or require additional surgery. One large prospective study found that over a third of patients undergoing SLAP repair met failure criteria, and reoperation rates in the literature have ranged from 3% to 15%.8,11

Biceps tenodesis takes a different approach. Rather than repairing the torn labrum, the damaged origin of the long head of the biceps tendon is detached from its anchor on the labrum and secured to the humerus (upper arm bone). This eliminates the peel-back forces that contributed to the SLAP tear in the first place, while preserving biceps function. For tennis players, this can mean fewer mechanical symptoms and a more predictable recovery.10

What Does the Evidence Show?

Multiple systematic reviews and meta-analyses have compared these two procedures. Both SLAP repair and biceps tenodesis reliably improve pain and shoulder function. Where the data become particularly relevant for athletes are the rates of return to sport, patient satisfaction, and reoperation.

A 2022 systematic review in Arthroscopy, Sports Medicine, and Rehabilitation found that in patients under 40 years old, return-to-sport rates were higher after biceps tenodesis (63–85%) compared with SLAP repair (50–76%), and reoperation rates were substantially lower after tenodesis.8 Another meta-analysis in the American Journal of Sports Medicine found that while functional outcome scores were similar between the two procedures in overhead athletes, biceps tenodesis showed at least non-inferior results with trends toward lower complication rates.7

It is important to note, however, that the most recent evidence also highlights considerable variability in outcomes for both procedures. A 2025 systematic review of 547 overhead throwing athletes across 16 studies found that return-to-play rates after both SLAP repair and biceps tenodesis can be quite variable, and that outcomes remain difficult to predict on an individual basis.9 In younger overhead athletes specifically, a comparative study found similar return-to-sport rates between the two procedures, though the SLAP repair group showed more improvement in sports participation level while the tenodesis group had fewer overall restrictions.14

What this means for you as a tennis player is that biceps tenodesis is increasingly favored when a SLAP tear is clearly linked to pathology at the biceps anchor, particularly in competitive or high-demand overhead athletes. However, the decision between SLAP repair and tenodesis should always be individualized based on your age, the specific pattern of your tear, any associated injuries, and your goals for competition. This is a nuanced conversation to have with your surgeon.

Returning to Tennis After Surgery

Regardless of which procedure is performed, a structured, phased rehabilitation program is essential for a successful return to tennis. Early phases focus on protecting the surgical site and gently restoring passive range of motion. As healing progresses, rehabilitation advances to strengthening of the rotator cuff, scapular stabilizers, and core musculature.15 Lower-extremity and kinetic-chain training is critical, since efficient force transfer from the legs through the trunk to the arm is what ultimately protects the shoulder during the serve and other overhead strokes.17

As strength and neuromuscular control improve, athletes transition to sport-specific drills—beginning with shadow swings, progressing to controlled groundstrokes, and ultimately returning to serves and overheads under the supervision of their rehabilitation team. For most overhead athletes, this process takes approximately nine to twelve months, though it can extend to eighteen months depending on individual healing and the demands of your level of play.15

The Bottom Line

Shoulder labral tears do not have to end your tennis career. With accurate diagnosis, individualized treatment planning, and coordinated rehabilitation, the large majority of players return to the court with confidence in their shoulder. If you are experiencing deep shoulder pain, catching, or a loss of power on your serve, I encourage you to seek evaluation from an orthopedic surgeon experienced in treating overhead athletes. The earlier these injuries are identified and addressed, the better your outcome is likely to be.

 

This blog post is intended for general educational purposes and does not constitute medical advice. Individual treatment decisions should be made in consultation with your orthopedic surgeon based on your specific condition and goals.

 

 

References

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  2. Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637-640. https://pubmed.ncbi.nlm.nih.gov/9754487/
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  8. Sandler AB, Scanlan SF, Galdi B, et al. Lower reoperation and higher return-to-sport rates after biceps tenodesis versus SLAP repair in young patients: a systematic review. Arthrosc Sports Med Rehabil. 2022;4(5):e1655-e1662. https://pubmed.ncbi.nlm.nih.gov/36312700/
  9. Lorentz BT, Cucchi JT, McHale CM, et al. Biceps tenodesis and SLAP repair show similar outcomes in overhead throwing athletes with baseball pitchers exhibiting worse rates of return to sport: a systematic review. Arthroscopy. 2025. https://pubmed.ncbi.nlm.nih.gov/39938668/
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Ellenbecker TS, Aoki R. Step by step guide to understanding the kinetic chain concept in the overhead athlete. Curr Rev Musculoskelet Med. 2020;13(1):109-118. https://pubmed.ncbi.nlm.nih.gov/31907773/