SLAP (Superior Labrum Anterior to Posterior) Lesion Repair

A SLAP tear is an injury to the labrum—the ring of cartilage that lines and stabilizes the shoulder socket (glenoid). The term stands for Superior Labrum Anterior to Posterior, describing a tear that extends from the front (anterior) to the back (posterior) of the top part of the labrum where the biceps tendon attaches. SLAP tears are common among athletes who perform repetitive overhead motions, such as baseball pitchers, swimmers, and tennis players, as well as among workers who perform heavy lifting.

How Common It Is and Who Gets It? (Epidemiology)

SLAP tears are increasingly recognized as a major cause of shoulder pain and dysfunction, especially in younger and active individuals. Overhead athletes and those with repetitive throwing or lifting activities are most at risk. Studies estimate SLAP lesions occur in 6–25% of patients undergoing shoulder arthroscopy for pain or instability. They are less common in the general population but can develop with aging, trauma, or repetitive strain.

Why It Happens – Causes (Etiology and Pathophysiology)

SLAP tears occur when the upper part of the labrum or its attachment to the biceps tendon becomes damaged due to repetitive stress or trauma. Common causes include:

• Overhead sports mechanics: Extreme external rotation during throwing (“peel-back” mechanism) places twisting tension on the biceps anchor.
• Repetitive overhead activity: Swimming, tennis, or heavy lifting causes gradual wear of the labrum.
• Acute trauma: Falling on an outstretched arm or sudden traction on the shoulder.
• Degeneration: Aging and chronic microtrauma weaken the labrum’s attachment over time.
• Scapular dyskinesis: Poor shoulder blade movement increases stress on the labrum and biceps tendon.

How the Body Part Normally Works? (Relevant Anatomy)

The shoulder is a ball-and-socket joint formed by the humeral head (ball) and the glenoid cavity (socket). The labrum deepens this socket and provides a secure base for the biceps tendon, which helps control shoulder motion. The labrum’s upper portion (superior labrum) is less vascularized, making it prone to poor healing. Variants like the sublabral recess and Buford complex are normal anatomic differences that can mimic SLAP tears on imaging.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with SLAP tears often report:

• Shoulder pain during overhead or throwing activities
• Clicking, catching, or popping sensations
• Weakness or fatigue with use
• Decreased throwing velocity or power
• Night pain or discomfort with reaching behind the back

How Doctors Find the Problem? (Diagnosis and Imaging)

Diagnosis begins with a detailed history and physical examination. SLAP tears can mimic other shoulder problems such as rotator cuff injuries or instability.

Physical tests used include:

• O’Brien’s Test
• Biceps Load Test II
• Speed’s Test
• Dynamic Labral Shear Test

Because no single test is fully reliable, imaging is often needed.

Imaging techniques:

• X-rays: Rule out fractures or arthritis but do not show labral tears.
• MRI with arthrogram (MRA): The most accurate imaging test for detecting SLAP tears. Contrast dye highlights tears between the labrum and glenoid.
• CT arthrogram: Used occasionally when MRI is inconclusive.

Procedure Types or Techniques (Classification)

SLAP lesions are classified according to the Snyder system:

• Type I: Fraying of the labrum without detachment.
• Type II: Detachment of the labrum and biceps tendon from the glenoid (most common).
• Type III: Bucket-handle tear of the labrum, but the biceps anchor remains intact.
• Type IV: Bucket-handle tear extending into the biceps tendon.

Expanded classifications (Types V–X) describe more complex tears that involve instability, other labral regions, or circumferential involvement.

Other Problems That Can Feel Similar (Differential Diagnosis)

Conditions that can cause similar symptoms include:

• Rotator cuff tears
• Biceps tendinopathy
• Shoulder impingement
• Internal impingement in athletes
• Glenohumeral instability
• Osteoarthritis of the shoulder
• Cervical spine nerve impingement

Treatment Options

Non-Surgical Care:

• Rest and avoidance of overhead activities
• Anti-inflammatory medications
• Physical therapy to restore shoulder and scapular strength
• Stretching to correct tight posterior capsule
• Scapular stabilization exercises

These approaches are effective for low-grade (Type I) tears or older, less active patients.

Surgical Care:
Surgery is indicated when conservative treatments fail or in younger, active individuals with significant tears.

Surgical procedures include:

• Arthroscopic debridement: Cleaning and smoothing frayed tissue (Type I or III).
• SLAP repair: Reattachment of the torn labrum and biceps anchor using suture anchors (Type II and IV).
• Biceps tenodesis or tenotomy: Detaching and reattaching the biceps tendon lower on the humerus, preferred for older or non-athletic patients.

Recovery and What to Expect After Surgery

After surgery, the arm is immobilized in a sling for 3–4 weeks.

• Weeks 0–4: Gentle pendulum and passive range-of-motion exercises.
• Weeks 4–8: Begin active range of motion.
• Weeks 8–12: Strengthening of the rotator cuff and scapular stabilizers.
• 4–6 months: Gradual return to sports and overhead activities.

Most patients experience significant improvement in pain and shoulder function within 6 months.

Possible Risks or Side Effects (Complications)

Potential complications include:

• Persistent stiffness or loss of motion
• Anchor migration or irritation
• Synovitis or inflammation around sutures
• Nerve irritation
• Recurrent pain, especially in overhead athletes

Modern knotless anchors reduce the risk of irritation and cartilage damage.

Long-Term Outlook (Prognosis)

Outcomes depend on the type of lesion, patient age, and activity level. Younger patients and non-throwing athletes have excellent results after repair. However, elite overhead athletes may struggle to return to their previous performance level.

• Return to sport: 85–90% for general athletes; lower for professional throwers.
• Pain relief: Achieved in over 90% of patients after proper repair or tenodesis.
• Function: Most regain near-normal range of motion and strength.

Out-of-Pocket Costs

Medicare

CPT Code 29822 – Limited Debridement (Arthroscopic Removal of Loose or Damaged Tissue): $129.58

CPT Code 29823 – Extensive Debridement (Arthroscopic Debridement Involving Multiple Structures): $141.21

CPT Code 29807 – SLAP Repair (Arthroscopic Repair of Superior Labrum Anterior to Posterior Lesion): $244.78

CPT Code 29828 – Biceps Tenodesis (Arthroscopic Fixation or Reattachment of Biceps Tendon): $216.87

CPT Code 29820 – Biceps Tenotomy (Arthroscopic Release of Biceps Tendon): $127.60

Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce the patient’s financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining balance, including coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your shoulder injury or biceps tendon condition requiring these procedures is related to a work-related injury, Workers’ Compensation will cover all medical expenses, including surgery, postoperative care, and rehabilitation. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder injury is the result of an automobile accident, No-Fault Insurance will typically cover the total cost of your treatment, including surgery and recovery. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your policy.

Example

Mark Johnson had shoulder pain from a torn labrum and biceps tendinopathy. He underwent SLAP repair (CPT 29807) and biceps tenodesis (CPT 29828). His estimated Medicare out-of-pocket costs were $244.78 for the SLAP repair and $216.87 for the biceps tenodesis. Since Mark had supplemental insurance through AARP Medigap, his remaining balances were fully covered, leaving him with no out-of-pocket expenses for the procedures.

Frequently Asked Questions (FAQ)

Q. What is a SLAP tear?
A. A SLAP tear is an injury to the superior part of the labrum in the shoulder, where the biceps tendon attaches to the labrum.

Q. What does SLAP stand for?
A. SLAP stands for Superior Labrum Anterior to Posterior.

Q. What are the common causes of a SLAP tear?
A. SLAP tears can be caused by trauma such as a fall on an outstretched arm, repetitive overhead activity, or a sudden pull on the arm.

Q. What are the symptoms of a SLAP tear?
A. Symptoms include pain with overhead activity, a sensation of locking or catching, decreased shoulder strength, and a feeling of instability.

Q. How is a SLAP tear diagnosed?
A. Diagnosis involves a physical exam, patient history, and imaging studies such as an MRI or MR arthrogram.

Q. What nonsurgical treatments are available for a SLAP tear?
A. Nonsurgical treatments include rest, anti-inflammatory medications, physical therapy, and activity modification.

Q. When is surgery recommended for a SLAP tear?
A. Surgery is recommended when nonsurgical treatments fail to relieve symptoms or if the tear is severe and affects shoulder function.

Q. What does SLAP repair surgery involve?
A. SLAP repair surgery involves reattaching the torn labrum to the bone using sutures and anchors, usually performed arthroscopically.

Q. How long does SLAP repair surgery take?
A. The surgery typically takes about one hour and is usually performed on an outpatient basis.

Q. What is the recovery time after SLAP repair surgery?
A. Recovery typically takes several months, with physical therapy starting soon after surgery and full activity resuming around 4 to 6 months.

Q. Will I need physical therapy after SLAP repair surgery?
A. Yes, physical therapy is crucial for regaining range of motion, strength, and function.

Q. Are there risks associated with SLAP repair surgery?
A. Risks include infection, stiffness, nerve injury, or failure of the repair.

Q. Can a SLAP tear heal without surgery?
A. Some SLAP tears can heal or become asymptomatic with conservative treatment, depending on the type and severity of the tear.

Q. What are the types of SLAP tears?
A. There are multiple types, with Type II being the most common and often requiring surgical repair.

Q. Is SLAP repair surgery effective?
A. Yes, many patients experience significant pain relief and improved shoulder function after SLAP repair surgery.

Q. Who is most at risk for a SLAP tear?
A. Athletes involved in overhead sports, such as baseball or tennis, and individuals with traumatic shoulder injuries are at higher risk.

Summary and Takeaway

A SLAP tear is a common cause of shoulder pain and instability, especially in overhead athletes and laborers. Diagnosis combines physical examination and MRI arthrogram findings. Treatment depends on the severity of the tear, age, and activity level—ranging from therapy and rehabilitation to arthroscopic repair or biceps tenodesis. When properly managed, patients can expect substantial pain relief and improved function.

Clinical Insight & Recent Findings

A recent study analyzed outcomes of different surgical techniques for treating superior labrum anterior to posterior (SLAP) tears, emphasizing patient selection based on age, activity level, and tear type.

Researchers reported that arthroscopic SLAP repair achieved high rates of pain relief and functional recovery in younger patients, while biceps tenodesis offered more predictable results and fewer complications in older or lower-demand individuals. Advances such as knotless suture anchors have minimized postoperative irritation and improved fixation strength, leading to better long-term satisfaction.

The study concluded that tailored treatment—combining accurate imaging, precise classification, and individualized surgical strategy—optimizes outcomes and shoulder stability for both athletes and non-athletes. (“Study of SLAP lesion management and surgical outcomes – see PubMed.”)

Who Performs This Surgery? (Specialists and Team Involved)

SLAP repair and related procedures are performed by orthopedic surgeons who specialize in shoulder and sports medicine. The team may include anesthesiologists, surgical nurses, and physical therapists who guide postoperative care and rehabilitation.

When to See a Specialist?

Consult a shoulder specialist if you experience persistent pain, clicking, or weakness during overhead movements despite rest and therapy. Early evaluation ensures timely treatment and prevents chronic instability.

When to Go to the Emergency Room?

Go to the emergency room if you suffer an acute shoulder dislocation, severe pain after a fall, or sudden inability to move the arm.

What Recovery Really Looks Like?

Recovery is gradual but rewarding. Most patients notice early pain relief after surgery, with motion and strength returning over several months. Adherence to physical therapy is crucial for achieving full recovery.

What Happens If You Delay Surgery?

Delaying surgery may cause the tear to enlarge, leading to progressive pain, biceps tendon damage, and shoulder instability. Early intervention improves outcomes and speeds rehabilitation.

How to Prevent Recurrence or Failure?

Proper rehabilitation, maintaining shoulder strength, and avoiding early overhead stress are key to preventing re-injury. Athletes should work with trainers to correct throwing mechanics and strengthen the rotator cuff and scapular muscles.

Nutrition and Bone or Joint Health

A nutrient-rich diet with lean protein, omega-3 fatty acids, and vitamins C and D supports tendon and cartilage healing. Avoid smoking and maintain hydration for optimal recovery.

Activity and Lifestyle Modifications

After recovery, patients should ease back into overhead sports with proper warm-up, conditioning, and technique adjustments. Avoid repetitive heavy lifting until cleared by the surgeon. With adherence to therapy and gradual return to activity, most individuals achieve long-term pain relief and stable shoulder function.