How Do SLAP Tears Affect Athletes?

Superior Labrum Anterior and Posterior (SLAP) tears are a common cause of shoulder pain and disability in overhead-throwing athletes, such as baseball pitchers, swimmers, volleyball players, tennis players, and quarterbacks. 

A SLAP injury involves a tear in the top part of the labrum – a thick ring of fibrous cartilage that lines the socket of the shoulder joint.

SLAP tears impact an athlete's ability to participate in sports, often leading to a hiatus of 3 to 9 months and sometimes prematurely ending their sports careers. 

Around 73% of professional athletes eventually return to sports after a SLAP tear injury.¹Sayde WM, Cohen SB, Ciccotti MG, Dodson CC. Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res. 2012;470(6):1595-1600. doi:10.1007/s11999-012-2295-6

How SLAP tears occur in athletes

The labrum cradles the top part of the upper arm bone in the shoulder socket and serves as an attachment site for the tendon of the biceps muscle.

Athletes usually develop SLAP tears through 2 mechanisms²Varacallo M, Tapscott DC, Mair SD. Superior Labrum Anterior Posterior Lesions. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538284/:

• Acute traumatic SLAP lesions occur when the labrum is damaged through compression forces or traction.
  • Compression injury: occurs when an individual falls on an outstretched arm 
  • Traction injury: occurs after lifting a heavy object or if the arm is unexpectedly pulled with sudden force
• Attritional SLAP lesions develop over time and involve the gradual tearing or fraying of the labrum due to microtrauma.
  Repetitive actions that involve extending the arm away from the body and upwards, such as a typical throwing motion, place excessive strain on the biceps tendon, leading to labral separation and tearing. 

Attritional SLAP lesions are the most common types of labrum tears observed in athletes, especially those involved in repetitive overhead activities.³Maldonado JA, Puentes DA, Quintero ID, González-Estrada OA, Villegas DF. Image-Based Numerical Analysis for Isolated Type II SLAP Lesions in Shoulder Abduction and External Rotation. Diagnostics (Basel). 2023;13(10):1819. Published 2023 May 22. doi:10.3390/diagnostics13101819

Recognizing the signs and symptoms of a SLAP tear

SLAP tears are characterized by deep shoulder pain when raising the arm in a throwing motion.²Varacallo M, Tapscott DC, Mair SD. Superior Labrum Anterior Posterior Lesions. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538284/ A popping, locking, and/or catching sensation also occurs with shoulder movements and activity.

A history of sports participation, shoulder instability, and/or sudden jerking force to the shoulder is almost always present.

Read more about SLAP Tear Symptoms

Treating SLAP tears in athletes

The first-line treatments for SLAP tears involve⁴LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS. 2021;6(4):204-211. doi:10.1136/jisakos-2020-000537: 

• Resting
• Immobilization
• Ice therapy
• Gentle physical therapy, which includes stretching and mobilization exercises and light sports-specific drills 
• Medication, such as non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroid injections

When non-surgical treatments fail and/or the symptoms become worse, surgery may be recommended to restore mobility and strength to the affected shoulder.

Read more about Labrum Tear Treatments

Factors affecting return to sports after a SLAP tear injury

An athlete's ability to return to the previous level of performance following a SLAP injury depends on several factors, including⁵Familiari F, Huri G, Simonetta R, McFarland EG. SLAP lesions: current controversies. EFORT Open Rev. 2019;4(1):25-32. Published 2019 Jan 28. doi:10.1302/2058-5241.4.180033:

• Nature of injury. The location of the SLAP tear and the extent of damage tend to influence the ability to return to sports, with more complex injuries requiring a longer recovery period.  
• Type of treatment. Non-surgical management requires 3-6 months before return to sporting activities, and surgery typically requires 6-9 months.
• Age of the athlete. Individuals older than 40 years have a longer rehabilitation period before returning to athletic activities after a SLAP tear.
• Concomitant injuries. Although concomitant injuries, such as rotator cuff tears and shoulder impingement, do not influence the rate of return to sports, these injuries raise the risk of post-surgical complications, potentially prolonging recovery.
• Type of sport. Athletes involved in overhead throwing sports, such as baseball pitchers, require a longer rehabilitation and have a lower rate of return to sports.

Adherence to the rehabilitation protocol ensures a timely recovery from a SLAP tear. 

Strategies for avoiding the recurrence of SLAP injuries

Specific recommendations for preventing re-injury vary based on individual circumstances. General guidelines include:

• Follow a carefully supervised and gradual return-to-sport protocol, which includes sport-specific drills and activities.
• Allow sufficient time for rest and recovery between intense training sessions or competitions.
• Consider using protective gear or braces as recommended by a healthcare provider or athletic trainer to provide additional support.
• Warm up before an activity or sport.
• Participate in regular cross-training activities to reduce the risk of overuse injuries.
• Maintain shoulder strength and conditioning throughout the season.

Athletes and individuals with a history of SLAP tears should have regular check-ups with their orthopedic surgeon or sports medicine specialist to monitor their shoulder health.