In many cases, a SLAP tear does not hurt all the time. The pain usually happens when you use your shoulder to complete a task, particularly an overhead activity. You may also notice a feeling of catching, locking, or grinding in the shoulder, along with loss of shoulder strength. Your shoulder range of motion may be decreased due to pain. The end of the day may be particularly painful.

SLAP tears can occur in anyone and sometimes may be part of normal aging. Athletes involved in sports that require repetitive overhead activities, such as baseball pitchers and volleyball players, are more likely to develop a SLAP tear. A traumatic event, such as falling down a flight of stairs or dislocating the shoulder, can also cause a SLAP tear.

There are three ways the labrum can tear: (1) overuse, (2) injury, and (3) degenerative. Overuse occurs when a repeated motion is performed in the shoulder which can result in a tear. This can be an overhead motion at work or a weightlifter who jerks a barbell up overhead again and again. Injuries that result in a SLAP tear can happen when you fall and stretch out your arm to break the fall or grab onto something. Finally, degenerative tearing occurs in the labrum with progressive wear-and-tear to the labrum over time, resulting in tearing or fraying. This is more common in people over the age of 40, as the cartilage becomes more brittle with age.

A SLAP tear is diagnosed through a combination of a detailed history, physical exam, and medical imaging. A discussion of your symptoms, when they first began, any recent injuries that may have caused your shoulder pain are part of a complete history. Any work activities or sports that aggravate your shoulder are also important to mention along with the location of your pain.
The physical exam is used to assess range of motion, strength, and stability of your shoulder. Specific tests that place your arm in different positions to reproduce your symptoms are valuable parts of the physical exam. The results of these tests will help decide if additional testing or imaging of the shoulder is required. An MRI with or without contrast is the best imaging study to evaluate a SLAP tear. An X-ray may also be ordered to make sure there are no other problems in the shoulder, such as arthritis or factures.

Initial treatment for a SLAP tear is nonsurgical in most cases. Medications to help with inflammation (otherwise known as nonsteroidal anti-inflammatory medications, or NSAIDs) are helpful to reduce pain and swelling. Physical therapy exercises can help improve shoulder movement, scapular mechanics, and increase shoulder strength. Flexibility and range-of-motion exercises involve stretching the shoulder capsule, which is the strong connective tissue surrounding the joint. These exercises to condition the shoulder can also help relieve pain and prevent further injury. Injection therapy with cortisone or orthobiologics may also provide symptomatic relief.
If you pain does not improve with conservative measures, surgery may be indicated. Arthroscopy is the type of surgery most commonly used to treat SLAP tears. This involves inserting a small camera into the shoulder joint to visualize the tissue. While visualizing with the camera, small surgical instruments are used either to repair the SLAP tear or to perform a biceps tenodesis, which decreases the tension on the labrum and provides pain relief. There are many different methods to repair a SLAP tear and it is important to work with your doctor to determine the best treatment option based on the type of SLAP tear, as well as your age, activity level, and presence of any other injuries.