Shoulder Labral Tear (SLAP Lesion)

The labrum is a ring of cartilage that deepens the shoulder socket, making the ball-and-socket joint more stable. A labral tear can occur from a traumatic event (shoulder dislocation, fall onto an outstretched arm) or from repetitive overhead loading (throwing, swimming, weightlifting).

A SLAP lesion (Superior Labrum Anterior to Posterior) is a specific type of labral tear at the top of the socket, where the biceps tendon attaches. It’s particularly common in overhead and throwing athletes.

How It Happens

• Shoulder dislocation or subluxation
• Fall onto an outstretched arm
• Repetitive overhead throwing (cricket, baseball, volleyball, swimming)
• Heavy overhead lifting — particularly with a sudden jerk or eccentric load
• Chronic shoulder instability

Symptoms

• Deep aching or sharp pain inside the shoulder (hard to point to)
• Clicking, catching or clunking with shoulder movement
• Pain in specific positions — often with the arm overhead or behind the back
• A feeling of the shoulder “slipping” or being unstable
• Weakness and reduced performance in throwing or overhead sport
• Biceps pain at the front of the shoulder (with SLAP tears)

Diagnosis

Shoulder labral tears are diagnosed with MRI (ideally with contrast — MR arthrogram). Clinical tests can suggest the diagnosis but imaging is required to confirm.

Non-Surgical Management

Many labral tears, particularly in older athletes and those with less demanding sport requirements, can be managed without surgery:

• Rotator cuff and periscapular strengthening to compensate for reduced passive stability
• Neuromuscular control and proprioception work
• Posterior capsule stretching (commonly tight alongside labral tears)
• Activity modification and technique correction in throwing athletes

Post-Surgical Rehabilitation

When surgery is performed (typically arthroscopic labral repair), we provide structured post-operative rehabilitation:

• Phase 1 (0–6 weeks): Sling, gentle range of motion
• Phase 2 (6–12 weeks): Progressive strengthening, full range of motion
• Phase 3 (3–6 months): Return to overhead activity and sport-specific training
• Return to Sport: Objective testing before clearance for contact or throwing sport