SLAP Tear Symptoms

A superior labral anterior to posterior (SLAP) tear injury is characterized by a persistent dull ache or sharp pain deep in the shoulder joint, which exacerbates with arm movements.¹Fitzpatrick S, Bishop JY, Cvetanovich GL. SLAP Tear Diagnosis and Management. The Management of Biceps Pathology: A Clinical Guide from the Shoulder to the Elbow. 2021 Jan 25:125

Labrum tears are sometimes associated with a tear of the biceps tendon, which causes additional symptoms.

What SLAP Tear Feels Like: Common Symptoms and Signs

Shoulder pain from a damaged labrum with or without a tear in the biceps tendon is typically felt at the front of the shoulder.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/

Symptoms and signs of a SLAP tear injury include¹Fitzpatrick S, Bishop JY, Cvetanovich GL. SLAP Tear Diagnosis and Management. The Management of Biceps Pathology: A Clinical Guide from the Shoulder to the Elbow. 2021 Jan 25:125^,3SLAP Tears - OrthoInfo - AAOS. Aaos.org. Published 2010. https://orthoinfo.aaos.org/en/diseases--conditions/slap-tears/:

• Pain that aggravates with overhead shoulder movements, such as lifting objects above the head, throwing a baseball, or hitting a tennis ball 
• A sensation of popping, clicking, or catching in the shoulder during shoulder movements
• Weakness and a decline in the strength of the affected shoulder
• A sensation of shoulder instability, as though the shoulder will "pop out" of its socket
• Arm stiffness and a reduced range of motion

If the SLAP tear injury is accompanied by a tear of the biceps tendon, the pain radiates from the shoulder into the arm.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/

Diagnosis of Shoulder Labral Tears

Evaluation of SLAP tear injuries involves reviewing the patient’s symptoms and signs and analyzing medical imaging tests.⁴LeVasseur 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

Review of medical history

The first step in a SLAP diagnosis is evaluation of the medical history, which includes reviewing²Varacallo 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/:

• The onset of pain
• Movements that make the symptoms less severe or worse
• History of participation in sports or other overhead activities
• Previous injury or trauma to the shoulder

Information from a medical history allows a physician to distinguish between SLAP tears and other shoulder injuries, such as rotator cuff tears.

Physical examination

While examining the shoulder area, the physician checks for:

• Signs of swelling, scars, asymmetry, or tenderness 
• Signs of shoulder instability 
• Shoulder range of motion

The O’Brien compression test is commonly used to identify SLAP tears.⁴LeVasseur 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

The test involves the physician moving the patient’s arm in different directions. If pain or clicking sounds are produced in the shoulder socket, it usually indicates a SLAP tear injury.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/

Imaging tests

Common diagnostic tests for labrum injuries include²Varacallo 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/:

• MRI scan: MRI scans conducted using a contrast agent, referred to as MRI arthrography, are more accurate than traditional MRI scans in detecting SLAP tears. 
• Diagnostic arthroscopy: involves the insertion of a narrow tube fitted with a fiber optic camera into the shoulder joint. 
• X-rays: helpful in ruling out damage or abnormalities of bony structures

While arthroscopy is considered the most reliable method for identifying SLAP tears, MRI is the most commonly used imaging technique for evaluating lesions in the labrum.⁴LeVasseur 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