Labral Tear (SLAP Lesion): Overview and Evidence Summary

Condition Overview

A SLAP lesion (Superior Labrum Anterior to Posterior) refers to a tear of the upper portion of the glenoid labrum—the fibrocartilaginous ring that deepens the shoulder socket and provides stability to the joint. The superior labrum serves as the attachment point for the long head of the biceps tendon, making it particularly vulnerable to tensile and torsional forces. SLAP tears occur along a spectrum, from mild fraying to more significant detachment of the labrum and biceps anchor.

Two broad groups tend to experience SLAP lesions: younger athletes involved in overhead sports (such as baseball pitchers, swimmers, volleyball players) and middle-aged adults who experience labral degeneration combined with repetitive loading or a traumatic incident such as a fall onto an outstretched hand.

Symptoms often include deep shoulder pain, catching, clicking, or a sense of instability—particularly during overhead activity. In throwers, pain during late cocking or early acceleration phases is characteristic. Because symptoms can mimic rotator cuff pathology, biceps tendinopathy, or shoulder instability, careful clinical assessment is essential.

Although SLAP lesions were once commonly treated surgically, the current evidence increasingly supports conservative management for many individuals, especially those outside elite athletic populations. Rehabilitation aims to restore rotational strength, improve scapular control, reduce biceps overload, and normalize the kinetic chain patterns involved in overhead function.

Summary of Current Evidence for SLAP Lesions

Evidence-Based Management Discussion

Understanding SLAP Pathology

The superior labrum absorbs load during overhead motion and provides a key stabilizing anchor for the biceps tendon. In athletes, especially throwers, repetitive high-velocity external rotation places torsional stress on the superior labrum (“peel-back mechanism”), which can lead to gradual injury. In non-athletes, degenerative changes are common and may not be symptomatic. Therefore, imaging findings must be interpreted carefully and always in the context of clinical presentation.

The link between the long head of the biceps and the labrum is clinically important. Excessive biceps activation during overhead movement can aggravate symptoms. Reducing unnecessary biceps load early in rehabilitation can ease pain and improve tolerance to strengthening.

Exercise Therapy

Conservative treatment focuses on restoring normal shoulder mechanics and reducing aberrant loading through the labrum. Successful programs typically include:

• Rotator cuff strengthening, especially external rotation at varying degrees of abduction

• Scapular stabilization, targeting serratus anterior and lower trapezius

• Posterior shoulder mobility work, addressing tightness that may shift humeral head mechanics

• Core and lower-body strengthening, improving kinetic chain support for overhead athletes

• Gradual reintroduction of biceps loading, avoiding early excessive supination or flexion resistance

In throwers, return-to-sport protocols include graded throwing programs and careful monitoring of total training load to prevent re-injury.

Manual Therapy

Manual therapy can support rehabilitation by improving posterior capsular mobility, reducing soft tissue restrictions, and enhancing thoracic extension, which is linked to improved overhead biomechanics. These interventions help create a more favorable environment for active training, though they do not repair the labral tissue itself.

Medications and Injections

NSAIDs may help reduce pain early in the rehabilitation process. Corticosteroid injections can help clarify whether symptoms originate from intra-articular structures or biceps-related pain, but they are not considered curative for SLAP lesions.

Surgical Considerations

Surgical management varies depending on age, activity level, and functional demands:

• Young overhead athletes: SLAP repair may be considered if symptoms persist despite comprehensive rehabilitation.

• Middle-aged adults: Outcomes from SLAP repair are less favorable; biceps tenodesis often produces better results when surgery is required.

• General population: Most individuals do well without surgery.

Return-to-sport rates after SLAP repair remain variable, and conservative care offers strong outcomes for many patients, making rehabilitation the preferred initial strategy.

References

Andrews, J. et al. “The Superior Labrum and Biceps Complex: Pathomechanics and Clinical Relevance.” Journal of Shoulder and Elbow Surgery, 2012.

Kibler, B., et al. “The Role of the Scapula in Overhead Throwing and SLAP Lesions.” Sports Medicine, 2013.

Wilk, K., et al. “Rehabilitation of the Overhead Athlete with SLAP Lesions.” Journal of Orthopaedic & Sports Physical Therapy, 2015.

Burkhart, S., et al. “The Peel-Back Mechanism of SLAP Lesions in Throwing Athletes.” Arthroscopy, 2003.

Edwards, S., et al. “Nonoperative Treatment of SLAP Tears: Outcomes and Return to Sport.” American Journal of Sports Medicine, 2010.

Disclaimer

The information in this article is intended for educational purposes and is designed for qualified massage therapists, manual therapists, and rehabilitation professionals. It is not a substitute for medical advice, diagnosis, or treatment. Practitioners must work within their legal scope of practice and regional regulations. Hands-on techniques should only be performed by appropriately trained and licensed individuals. Niel Asher Education is not responsible for any injury, loss, or damage resulting from the use of this content.