The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Shoulder

SLAP Tear

A SLAP tear is a specific injury to the labrum at the top of the shoulder socket, most commonly affecting overhead athletes — baseball pitchers, swimmers, volleyball players — and those who sustain traction or fall-on-outstretched-arm injuries. At Maryland Orthopedic Specialists, our sports medicine surgeons are experienced in both diagnosing subtle SLAP pathology and selecting the most appropriate treatment: repair, biceps tenodesis, or structured rehabilitation depending on your age, activity demands, and tear type.

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What is slap tear?

SLAP stands for Superior Labrum Anterior to Posterior. The superior labrum is the fibrocartilaginous rim at the top of the glenoid (shoulder socket) that deepens the joint cavity, provides stability, and serves as the anchor point for the long head of the biceps tendon.

SLAP stands for Superior Labrum Anterior to Posterior. The superior labrum is the fibrocartilaginous rim at the top of the glenoid (shoulder socket) that deepens the joint cavity, provides stability, and serves as the anchor point for the long head of the biceps tendon. A SLAP tear involves detachment or disruption of this superior labral tissue, extending both in front of and behind the biceps anchor.

Snyder Classification (Types I–IV)

The most widely used classification was described by Snyder in 1990:

  • Type I: Fraying and degeneration of the superior labrum without detachment; the biceps anchor is intact. Common incidental finding in older patients.
  • Type II (most common, ~55%): Detachment of the superior labrum and biceps anchor from the glenoid rim. The most clinically significant type requiring surgical treatment when symptomatic.
  • Type III: Bucket-handle tear of the superior labrum with an intact biceps anchor; the central fragment may displace into the joint.
  • Type IV: Bucket-handle tear extending into the biceps tendon itself; the biceps tendon is split.

Type II SLAP tears are subdivided by location (anterior, posterior, or combined) and represent the primary surgical target.

Mechanisms of Injury

SLAP tears arise via two principal mechanisms:

  1. Overhead throwing (traction-compression): The repetitive peel-back forces of the late cocking and early acceleration phases stress the posterior biceps anchor. Common in baseball pitchers, tennis players, and swimmers.
  2. Traction injuries: Sudden inferior traction — catching a heavy falling object, a shoulder dislocation — can avulse the labrum from the glenoid.
  3. Compressive load (fall on outstretched hand): Drives the humeral head superiorly, shearing the superior labrum.

Treatment options

Non-Operative Management

Many patients — particularly those with Type I tears, older patients, or those with low overhead demands — respond well to a structured physical therapy program focusing on rotator cuff strengthening, posterior capsular stretching (sleeper stretches), and scapular stabilization. Three to six months of dedicated PT is pursued before surgical consideration.

Surgical Procedure

Shoulder Arthroscopy (Diagnostic & Operative)

Minimally invasive diagnostic and operative scope of the glenohumeral joint and subacromial space, used to evaluate and treat labral tears, rotator cuff pathology, AC joint arthritis, loose bodies, and synovitis.

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SLAP Repair

Arthroscopic suture anchor repair of the superior glenoid labrum (SLAP) for overhead athletes with symptomatic type II tears. Patient selection is critical — biceps tenodesis is preferred for patients over 35 or with concurrent biceps pathology.

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Biceps Tenodesis

Surgical detachment of the long head of the biceps tendon from its labral origin and reattachment to the proximal humerus, eliminating biceps tendon pain and SLAP-related symptoms while preserving elbow flexion and supination strength.

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Frequently Asked Questions

Can a SLAP tear heal without surgery?
Type I SLAP tears (fraying only) and many Type II tears in non-overhead athletes can be managed successfully with PT. Surgery is reserved for those with persistent symptoms despite adequate conservative treatment.
Should I have a SLAP repair or a biceps tenodesis?
This depends heavily on age and activity level. For young competitive overhead athletes (especially pitchers under 35), SLAP repair is often preferred. For patients over 35 or those who are not competitive overhead athletes, biceps tenodesis offers reliable pain relief with a faster recovery and lower re-operation rate.
How long until I can pitch again after SLAP repair?
Most pitchers return to competitive throwing at 9–12 months. Return at 6 months is possible for position players or non-pitching overhead athletes.
What is a SLAP tear and how does it happen?
SLAP stands for Superior Labrum Anterior to Posterior, referring to a tear in the top portion of the cartilage ring (labrum) that surrounds the shoulder socket, specifically where the biceps tendon attaches. In overhead athletes, SLAP tears typically develop from the repetitive "peel-back" forces generated during the cocking phase of throwing, which gradually stress the posterior superior labrum. They can also result from a single traumatic event, such as a fall onto an outstretched arm or a sudden traction injury. Symptoms include deep shoulder pain, a catching or popping sensation, and decreased velocity or accuracy in throwers.
How will I know if I need a SLAP repair or a biceps tenodesis?
The choice between SLAP repair (reattaching the labrum to the socket) and biceps tenodesis (moving the biceps attachment to the upper arm bone) depends largely on your age, activity level, and the specific tear pattern. In younger competitive overhead athletes — particularly pitchers — SLAP repair preserves the native anatomy that throwing mechanics depend on and is generally preferred when tissue quality is good. In recreational athletes, patients over 35–40, or those with associated biceps tendon degeneration, biceps tenodesis tends to produce more reliable and durable results with lower re-tear rates. Your MOS surgeon will review your MRI, physical examination findings, and athletic goals to recommend the approach most likely to get you back to what you love.

Meet the specialists

Christopher S. Raffo, MD

Christopher S. Raffo, MD

Orthopedic Surgery · Sports Medicine

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John J. Christoforetti, MD

John J. Christoforetti, MD

Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery

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James S. Gardiner, MD

James S. Gardiner, MD

Orthopedic Surgery · Sports Medicine

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Related conditions

Shoulder InstabilityRotator Cuff TearsBiceps Tendinitis / Proximal Biceps Tendon Rupture
Medically reviewed by Christopher S. Raffo, MD
Last reviewed June 12, 2026

References

  1. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–279. doi: 10.1016/0749-8063(90)90056-J.
  2. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D. A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med. 2013;41(4):880–886. doi: 10.1177/0363546513477363.
  3. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated type II SLAP lesions. Am J Sports Med. 2009;37(5):929–936. doi: 10.1177/0363546508330127.
  4. Denard PJ, Lädermann A, Burkhart SS. Long-term outcome after arthroscopic repair of type II SLAP lesions: results according to age and workers' compensation status. Arthroscopy. 2012;28(4):451–457. doi: 10.1016/j.arthro.2011.09.005.
  5. Gorantla K, Gill C, Wright A. The outcome of type II SLAP repair: a systematic review. Arthroscopy. 2010;26(4):537–545. doi: 10.1016/j.arthro.2009.08.017.
  6. American Academy of Orthopaedic Surgeons. SLAP Tears. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/slap-tears/