SLAP Tear

Your shoulder socket is shallow on its own — the rim of cushion around it (the labrum) deepens the socket and acts as the anchor point for the biceps tendon. A SLAP tear is a tear at the top of that rim, right where the biceps attaches. The name stands for Superior Labrum Anterior to Posterior — meaning the tear runs across the top from front to back. The most clinically important version (Type II) is when that biceps anchor itself pulls loose. SLAP tears happen from falling onto an outstretched arm, a sudden hard pull on the arm, or repeated overhead loading — pitchers and other throwers see them most from the twisting forces of the cocking phase.

• Deep pain in the front or top of the shoulder, especially with overhead motions like throwing or reaching up
• A catching, clicking, or popping sensation inside the joint during certain arm movements
• Pain that worsens with overhead loading — throwing a ball, serving in tennis, pressing weight overhead
• A dead-arm feeling after throwing — a brief loss of strength or control mid-throw
• Pain with biceps-loading activities: carrying heavy bags, curling, or pulling motions
• Night pain when rolling onto the affected shoulder

Deep shoulder pain with overhead activity, sometimes clicking or a catching feeling. Your provider runs through specific maneuvers (the O'Brien test, the Biceps Load II) that load the biceps anchor and reproduce the pain — these are moderately sensitive. The best imaging test is an MRI with contrast injected into the joint (MRI arthrography), but SLAP tears are notoriously hard to diagnose with confidence on imaging alone. The gold standard is arthroscopy — looking inside the joint with a small camera, often with treatment in the same setting.

The decision tree is age-driven. Younger throwing athletes with a confirmed Type II SLAP tear who haven't responded to a structured rehab program are candidates for an arthroscopic labral repair — stitching the labrum back down to the rim of the socket. Older patients (typically 35+) with SLAP tears do better with a biceps tenodesis — the biceps tendon is detached from the labrum and reattached to the upper arm bone instead. Tenodesis takes the unstable biceps anchor out of the equation and tends to be more reliable than repair in this older group.

External patient-education references and related OSI pages for additional background:

• Britannica — Shoulder (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language