Shoulder
SLAP Tear (Superior Labrum)
SLAP 파열 (상부 관절순)
Tear of the superior labrum from anterior to posterior where the long head biceps attaches
- How common
- Moderate (throwing athletes)
- Typical age
- Young adult athletes
What is it?
Throwing injuries or FOOSH trauma cause superior labrum tears at the LHB origin — classified Types I–IV.
Commonly affected: Superior labrum (11–2 o'clock position)
How it develops
- Normal Labrum + LHB AnchorLHB anchors into superior labrum for stability
- Throwing/TraumaThrowing or FOOSH applies acute/repetitive load
- SLAP TearSuperior labrum tears antero-posteriorly
- Catching/InstabilityTorn labrum catches, causes instability
Symptoms
- Deep Shoulder PainPoorly localized, deep anterior/posterior pain
- Catching/ClunkingMechanical catching, esp. with throwing
- Weakness/InstabilityLoss of throwing velocity or sense of instability
- Night PainPain disturbs sleep
How it is examined
- O'Brien TestPain with internal rotation, relieved with external rotation = positive
- Biceps Load IIPain with resisted elbow flexion at 120° external rotation
- Crank TestAxial load + rotation at 160° flexion reproduces pain
Imaging
X-ray typically normal — rules out bony pathology.
- Usually normal
- May show Bankart lesion
MR arthrography (MRA) is most sensitive.
- Superior labrum tear
- LHB anchor abnormality
- Intra-articular contrast leak
Non-surgical care
- Rest + PTThrowing rest 4–6 weeks, scapular/RC strengthening
- NSAIDsShort-term NSAIDs
- Intra-articular SteroidConsidered for symptom control
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
6-month conservative failure, return-to-throw, Type II+ with dysfunction
Procedures that may be discussed
- Arthroscopic SLAP repair
- Biceps tenodesis
- Combined approach
Outlook
Return-to-throw ~60–70%; non-throwing patients do better.