Overhead Shoulder Injuries — Melbourne

SLAP Lesion (Superior Labrum Anterior to Posterior): Symptoms, Diagnosis, Treatment & Recovery

We provide diagnosis-first care for SLAP lesions—tears of the superior shoulder labrum where the long head of biceps anchors. Our integrated surgeons–physiotherapists team focuses on relieving pain, restoring overhead function, and guiding a safe return to work and sport.

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What Is a SLAP Lesion?

A SLAP lesion is a tear of the superior labrum that extends from the front (anterior) to the back (posterior) of the shoulder socket, often involving the biceps anchor. The labrum deepens the socket and aids stability; when torn, it can cause painful clicking, catching, and loss of power overhead.

Type I: fraying of the superior labrum with intact biceps anchor.
Type II: detachment of the superior labrum/biceps anchor (most common clinically).
Type III–IV: bucket-handle tear; Type IV extends into the biceps tendon.
Complex variants may extend into anterior/posterior labrum or co-exist with instability.

Common Symptoms

Deep shoulder pain with overhead activity, throwing, or lifting.
Clicking, catching, or popping near the top/front of the shoulder.
Loss of power or endurance, especially in late-cocking/acceleration (throwers).
Night pain when lying on the affected side.
Occasional instability sensation or “dead arm” feeling in athletes.

Why SLAP Lesions Occur — Causes & Risk Factors

Repetitive overhead loading (throwing, swimming, tennis, manual trades).
Trauma—fall onto an outstretched hand, sudden traction, heavy lift, or shoulder dislocation.
Posterior capsule tightness and scapular dyskinesis altering joint mechanics.
Age-related change—degenerative superior labral fraying in middle age and beyond.
Co-existing problems: subacromial impingement, instability, or rotator cuff pathology.

How We Diagnose a SLAP Lesion

Diagnosis combines a focused history (pain pattern, sport/occupation), targeted examination, and—when indicated—advanced imaging. We also assess contributing factors such as posterior shoulder tightness and scapular control.

Clinical assessment

Provocation tests: O’Brien/Active Compression, Crank, Dynamic Labral Shear, Speed/biceps tests.
Evaluation of rotator cuff, biceps tendon, and instability signs.

Imaging

X-rays to assess bony architecture and rule out alternative causes.
MRI arthrogram improves visualisation of the superior labrum and biceps anchor.
Diagnostic injection (image-guided) can help localise pain to the joint vs. subacromial space.

Non-Operative Treatment (First-Line)

Many patients—especially with Type I/degenerative lesions—improve without surgery. We coordinate a structured program with our physiotherapy team.

1) Education & load modification

Short-term reduction of provocative overhead/throwing volume; adjust technique and workloads.
Ergonomic changes for manual tasks and gym programming (pressing angle, range, tempo).

2) Mobility

Address posterior capsule tightness (sleeper/cross-body stretch variants).
Thoracic extension and rotation; pectoralis minor lengthening as indicated.

3) Strength & motor control

Scapular control: serratus anterior and lower/middle trapezius progression.
Rotator cuff endurance in safe ranges; kinetic-chain integration for throwers.

4) Medications & injections

Short courses of analgesics/anti-inflammatories where appropriate.
Targeted intra-articular or biceps sheath corticosteroid injection in irritable cases to enable rehab (selected patients).

Timeline: Many improve in 6–12 weeks with consistent rehab. Persisting pain, mechanical catching, or high-demand sport goals may prompt a surgical discussion.

Surgical Options (When Symptoms Persist)

We tailor surgery to age, tissue quality, sport/occupation, and tear type, favouring procedures that optimise function and durability.

Arthroscopic debridement for Type I fraying with stable biceps anchor.
SLAP repair (arthroscopic) for acute Type II tears in younger overhead athletes with clear mechanical symptoms.
Biceps tenodesis (or tenotomy) for degenerative Type II/IV lesions, patients >30–35 years, labourers, and those with biceps-dominant pain—often provides more reliable pain relief and faster recovery than repair in these groups.
Address co-pathology as required (cuff, impingement, instability). See: Biceps Tenodesis and Shoulder Arthroscopy.

Risks & considerations

Infection, bleeding, clots (rare), stiffness, persistent pain.
Failure or irritation of anchors (repair) or cramping/cosmesis issues (tenotomy).
Nerve irritation (rare), re-tear with premature loading.

Recovery & Return to Sport

After SLAP Repair

Weeks 0–4: sling protection; passive/assisted range; avoid biceps loading.
Weeks 6–12: active range, scapular/cuff strengthening; begin light functional tasks.
Months 3–4: progressive strengthening; begin interval throwing if criteria are met.
Months 5–6+: sport-specific drills; full return when objective testing and symptoms allow.

After Biceps Tenodesis

Weeks 0–2: sling for comfort; early passive range; protect resisted elbow flexion/supination.
Weeks 3–6: active range; gradual cuff/scapular strengthening; light biceps activation as guided.
Weeks 6–12: progress strengthening; work/sport skills as criteria allow.
Months 3–4+: return to overhead sport or heavy work once pain-free strength and control benchmarks are achieved.

We use a criteria-based pathway (movement quality, strength symmetry, endurance, task testing) rather than fixed dates to reduce re-injury risk.

When Should I See a Shoulder Specialist?

Persistent deep shoulder pain, clicking, or catching with overhead use.
Loss of throwing power or endurance despite physiotherapy.
Ongoing night pain or biceps-front shoulder tenderness.
Post-traumatic onset after fall, traction, or dislocation.

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SLAP Lesion — FAQs

Is a SLAP tear the same as biceps tendinitis?

No. A SLAP tear involves the superior labrum/biceps anchor inside the joint. Biceps tendinitis is irritation of the tendon in its groove outside the joint—both can coexist.

Who should consider SLAP repair vs biceps tenodesis?

We favour SLAP repair for younger overhead athletes with acute Type II tears. Biceps tenodesis suits many patients over 30–35, labourers, and those with degenerative lesions or biceps-dominant pain.

Will physiotherapy fix a SLAP lesion?

Many improve with targeted rehab that restores scapular/cuff control and mobility, even if the labrum remains torn. Persistent catching, power loss, or sport demands may require surgery.

How long until I can throw again?

After repair, interval throwing often begins around 3–4 months if criteria are met, with competitive return later. After tenodesis, progressions may begin earlier depending on role and testing.

Are anchors permanent?

Yes. Suture anchors used in labral repair remain in place. They are biocompatible; most patients are unaware of them after healing.