SLAP Tears of the Shoulder: Causes, Diagnosis and Treatment in Dallas

What is a SLAP tear? It is a tear of the labrum at the very top of the shoulder socket, right where the biceps tendon attaches. SLAP stands for superior labrum, anterior to posterior: the top of the labrum, torn from front to back. SLAP tears happen in throwing athletes, after a fall or a sudden pull on the arm, and, very commonly, as part of normal wear after about age 40, when the MRI often shows fraying that causes no pain at all. Most SLAP tears are treated without surgery first. When surgery is needed for a SLAP tear on its own, Dr. Brett Raynor usually performs a biceps tenodesis, which moves the biceps tendon off the torn labrum and reattaches it lower on the arm bone. He repairs the SLAP tear when it is part of a larger tear that includes the back (posterior) labrum.

Dr. Raynor is a fellowship-trained orthopaedic sports medicine surgeon at Texas Orthopaedic Associates in Dallas and team physician for the U.S. Ski and Snowboard Team, Highland Park High School, St. Mark's School of Texas, Hockaday and Ursuline Academy.

This page is about the top of the labrum, usually without a dislocation. If your shoulder has come out of the socket, see shoulder dislocations and shoulder instability.

Key points

• The labrum is a rim of firm tissue around the edge of the shoulder socket. The long head of the biceps tendon anchors to its top. A SLAP tear is a tear at that anchor.

• Many SLAP tears seen on MRI do not cause symptoms. In one study of people aged 45 to 60 with no shoulder pain at all, radiologists read a SLAP tear on 55 to 72 percent of the MRIs (Schwartzberg et al., Orthop J Sports Med, 2016). The examination decides whether the tear is the problem.

• Treatment usually starts with physical therapy and time.

• When surgery is needed, the options are repairing the labrum back to the bone or a biceps tenodesis. Dr. Raynor usually treats a SLAP tear on its own with a biceps tenodesis, and repairs it when it is part of a larger tear that includes the back of the labrum.

The top of the labrum and the biceps anchor

The shoulder is a ball and socket, and the socket is shallow, like a golf ball sitting on a tee. The labrum is a rim of firm tissue around the edge of the socket that deepens it, like a bumper. At the top of the socket, the labrum and the long head of the biceps tendon join. The biceps tendon runs up a groove at the front of the arm bone, turns into the shoulder joint, crosses over the top of the ball and anchors there.

That anchor takes a pull every time the biceps works and every time the arm is thrown or yanked. A SLAP tear is the labrum at that anchor peeling or fraying away from the top of the socket. Some tears are only frayed edges. Others leave the biceps anchor loose, so the biceps pulls the torn labrum away from the bone when the arm moves.

When a SLAP tear extends down the labrum below the equator (the middle of the socket), it starts to create shoulder instability. See shoulder dislocations and shoulder instability.

What causes a SLAP tear

• Throwing and overhead sports. Repeated throwing, serving and spiking load the biceps anchor at the top and back of the socket with every motion. Baseball pitchers are the classic example.

• A fall on an outstretched arm. The ball of the shoulder is driven up into the top of the socket.

• A sudden pull on the arm. Catching something heavy that falls, or a hard jerk on the arm, can pull the biceps anchor off the bone.

• Age-related fraying. After about 40, the top of the labrum frays and thins with normal wear, often with no injury and often with no symptoms. This is the most common SLAP "tear" on an MRI report, and it is usually not what is causing the pain.

Symptoms of a SLAP tear

• Pain deep in the shoulder, often felt at the top or the back, hard to point to with one finger

• Pain with overhead activity, throwing, or lifting with the arm out in front

• Clicking, popping or catching inside the shoulder with certain motions

• In throwers, a loss of velocity or control, or a "dead arm" feeling during the throwing motion

• Pain at the front of the shoulder along the biceps tendon, since the biceps and the top of the labrum are joined

None of these is specific to a SLAP tear. The same symptoms come from the rotator cuff, the biceps tendon in its groove, and the joint at the top of the shoulder, which is why the examination matters more than any single symptom.

How a SLAP tear is diagnosed

Dr. Raynor starts with the history and an examination: where the pain is, what brings it on, and a set of tests that load the biceps anchor, the rotator cuff and the rest of the shoulder separately. X-rays are taken to look at the bones and joint.

An MRI shows the labrum, the biceps tendon and the rotator cuff, and is often needed to sort out which one is the problem. Many patients arrive with an MRI already. A standard MRI often shows the problem, especially on a high-strength (3 Tesla) scanner. When Dr. Raynor is looking for other labral tears, such as with instability, or is very suspicious of a tear and the scanner is not high-strength, he may order an MRI with dye injected into the joint (an MRI arthrogram).

Every MRI has to be read with care. Fraying of the top of the labrum is common with age and is often painless: in people aged 45 to 60 with healthy, pain-free shoulders, radiologists read a SLAP tear on more than half of the MRIs (Schwartzberg et al., Orthop J Sports Med, 2016). A SLAP tear on an MRI report is a finding, not a diagnosis. Dr. Raynor puts the MRI together with the examination before calling the labrum the cause of your pain.

Treatment without surgery

Most SLAP tears are treated without surgery first, and many people get better. Non-surgical care typically includes:

• Rest from the motions that hurt, including a break from throwing or overhead sport while the shoulder settles down.

• Physical therapy. Strengthening the rotator cuff and the shoulder blade muscles, and stretching the back of the shoulder, which is often tight in throwers. Both studies below used a program built on those two things.

• Anti-inflammatory medicine, when it is safe for you to take.

• A steroid injection. One or two injections can be part of non-surgical care. Dr. Raynor limits steroid injections because more than two can damage the tissues of the shoulder.

How well does it work? In one small series of 39 patients with a SLAP tear, about half did well enough with therapy and anti-inflammatory medicine to avoid surgery, and all of those patients returned to their sports (Edwards et al., Am J Sports Med, 2010). In professional baseball pitchers with a SLAP tear, 40 percent returned to play after a structured therapy program, compared with 48 percent of pitchers who had surgery, and more of the therapy group returned to their previous level of performance (22 percent versus 7 percent) (Fedoriw et al., Am J Sports Med, 2014). For the overhead athlete, a full course of therapy usually comes before any operation.

When surgery makes sense

Surgery is worth considering when pain from a SLAP tear keeps you from your work or your sport after a reasonable course of non-surgical care, and the examination and the MRI agree that the top of the labrum and the biceps anchor are the source.

There are two main operations:

• SLAP repair. Small anchors made of suture are placed in the top of the socket, and the torn labrum and biceps anchor are stitched back to the bone. Dr. Raynor repairs a SLAP tear when it is part of a larger tear that includes the back (posterior) labrum.

• Biceps tenodesis. The biceps tendon is released from the top of the socket and reattached lower on the arm bone, at the top of its groove. The biceps no longer pulls on the torn labrum, and the frayed labrum is cleaned up. This is how Dr. Raynor usually treats a SLAP tear on its own.

SLAP repair or biceps tenodesis? What the research shows

The choice between the two has been studied closely, and the research has moved over the last fifteen years.

• Repairs do not hold up for everyone. In a prospective study of 179 SLAP repairs in young, active patients, 37 percent met the study's definition of failure and 28 percent had a second surgery. Patients older than 36 were more likely to fail (Provencher et al., Am J Sports Med, 2013). A review of SLAP repair in patients 40 and older found more stiffness, more second surgeries and lower satisfaction as age goes up, and found biceps tenodesis a reliable alternative (Erickson et al., Am J Sports Med, 2015).

• Tenodesis compares well. Across five comparative studies (234 patients), patients who had a biceps tenodesis were more often satisfied (95.6 percent versus 76.2 percent) and more often returned to sport (81.3 percent versus 64.3 percent) than patients who had a SLAP repair, with similar function scores (Hurley et al., J Shoulder Elbow Surg, 2018).

• In patients younger than 40, a review of four comparative studies found similar pain relief and function after either operation, with higher return-to-sport rates after tenodesis (63 to 85 percent versus 50 to 76 percent) and fewer second surgeries (0 to 6 percent versus 3 to 15 percent) (Sandler et al., Arthrosc Sports Med Rehabil, 2022).

• In overhead athletes, a meta-analysis found tenodesis no worse than repair for function, return to sport and complications (Shin et al., Am J Sports Med, 2022). Baseball pitchers are the hardest group: return to play varies widely after either operation and is lower for pitchers than for position players (Lack et al., Arthroscopy, 2025).

• Not every SLAP tear needs either. In a randomized trial of 118 patients (average age 40) with a SLAP tear, patients who had a repair, a tenodesis, or an arthroscopy with neither did equally well at six months and two years (Schrøder et al., Br J Sports Med, 2017). That is one more reason to be sure the tear is the cause of the pain, and to give non-surgical care a fair try, before operating.

Dr. Raynor's approach. For a SLAP tear on its own, Dr. Raynor usually performs a biceps tenodesis. When the SLAP tear is part of a larger tear that includes the back (posterior) labrum, he repairs the SLAP tear together with the back of the labrum. He will go through which operation fits your shoulder, your age and your sport.

How Dr. Raynor performs a biceps tenodesis for a SLAP tear

The operation is usually arthroscopic, through small poke holes, as a same-day surgery. An anesthesiologist places an interscalene nerve block in the operating room just before you go to sleep, which numbs the shoulder and arm for about one to three days, and you have general anesthesia. Dr. Raynor examines the whole joint first, including the labrum, the biceps tendon, the cartilage and the rotator cuff. The biceps tendon is secured with a stitch, released from the top of the socket, and anchored into the bone at the top of its groove, where it heals. The frayed labrum at the top of the socket is cleaned up. Sometimes the tendon is still reattached a little lower on the arm through a small incision near the armpit (an open subpectoral tenodesis); the goal is the same.

The biceps tenodesis page walks through the operation step by step.

Recovery after a biceps tenodesis for a SLAP tear

A biceps tenodesis done on its own has a much shorter, lighter recovery than a rotator cuff repair or a labral repair after a dislocation.

• Sling for comfort for a week or two, and the shoulder can move through its full range right away.

• Physical therapy starts 1 to 2 weeks after surgery.

• No resisted elbow bending, no curls and no carrying things with the elbow bent, for about 12 weeks, while the tendon heals into the bone.

• No carrying things with the arm straight at your side, either, for about 12 weeks.

• Strengthening starts at 3 months.

• No heavy lifting for 3 to 4 months.

• Driving: be cautious for the first 6 weeks. Some people can drive after about 2 weeks, once they are out of the sling.

• Work: desk work as soon as you are off prescription pain medication and the nerve block has worn off. Physical labor waits at least 3 to 4 months, because the tendon has to heal and be protected.

• Exercise and sports: back to the gym at 3 months, golf at 4 months, contact sports at about 4 months, and overhead sports at 4 to 6 months.

• No real restrictions after 3 to 4 months, apart from the timing for golf and overhead sports.

The biceps tenodesis recovery roadmap walks through each stage.

If your SLAP tear was repaired together with the back of the labrum, your recovery follows the labral repair, not the tenodesis timeline above. See recovery after shoulder stabilization surgery.

Frequently asked questions about SLAP tears

Expand any question below.

Why patients choose Dr. Raynor for shoulder care

• Fellowship-trained in sports medicine at the Steadman Philippon Research Institute in Vail, Colorado

• Board-certified orthopaedic surgeon; D Magazine Best Doctor every year since 2019

• Team physician for the U.S. Ski and Snowboard Team, Highland Park High School, St. Mark's School of Texas, Hockaday and Ursuline Academy

• More than 800 five-star Google reviews

Make an appointment

Call (214) 265-3211, schedule online, or send an appointment request. Texas Orthopaedic Associates, 7115 Greenville Avenue, Suite 310, Dallas, TX 75231.

Written and medically reviewed by M. Brett Raynor, M.D., board-certified orthopaedic sports medicine surgeon. Last reviewed October 2026. General information for patients; it does not replace an examination.