SLAP Tear Types and Treatments

A SLAP tear is an acronym describing a labral tear or lesion of cartilage in the inner portion of the shoulder joint. It means Superior Labral tear from Anterior to Posterior. The labrum is an integral part of the shoulder and a tear affects your full range of motion, especially overhead motion, which can lead to significant pain and limited movement.

The All Important Shoulder Labrum

The shoulder labrum is a ring of cartilage that sits between the shoulder socket (glenoid) and the upper arm bone (humerus). The labrum provides needed cushion and allows the full range of motion between the two bones.

A SLAP tear can occur over time due to age, sudden trauma, or certain repetitive motions. Similar to other kinds of shoulder injuries, it can also happen in a car accident, if you fall on an outstretched arm, a dislocation, or forceful movement of the arm above shoulder level.  If a tear occurs, it is painful and obstructs movement of the shoulder joint. 

Bicycle accident. Biker holding his shoulder.

Type 1 SLAP Tear

This type of tear describes fraying at the top of the cartilage, but leaves the labrum attached to the glenoid. It usually occurs as one ages and is found frequently in middle aged and older adults.

Sometimes there may be little to no symptoms experienced by the patient from a type 1 SLAP tear. This injury can normally be treated without surgery, and can be managed using over-the-counter anti-inflammatory medications and perhaps physical therapy.

Type 2 SLAP Tear

This is the most common type of tear to the shoulder labrum. In this situation, the labrum and bicep tendon do detach from the glenoid and result in a dislocated shoulder. This can occur either to the anterior or posterior sides.

In most cases, Type 2 is treated by Dr. Samuel Koo with arthroscopic surgery.

Type 3 SLAP Tear

With a type 3 SLAP tear, the labrum collapses into the shoulder joint, while the bicep tendon remains in place. This particular injury is also commonly referred to as a bucket-handle tear due to the appearance of the labrum once it has detached and begun to droop.

Treatment options for a type 3 SLAP tear include arthroscopic surgery to remove the collapsed segment and repair any other unstable portions of the shoulder.

Type 4 SLAP Tear

Type 4 is similar to the above type 3, except that the collapsed labrum has not fully detached. Instead, the labrum hangs down and extends into the bicep tendon, which often causes symptoms of popping or locking within the shoulder joint.

Treatment can vary depending on how extensive the damage to the bicep tendon is, as the tendon may require repair in addition to the torn labrum.

Typical Treatment Protocols for SLAP Tears

Typically, these tears are treated conservatively with anti-inflammatory medications. Physical therapy may also be recommended to improve the patient’s range of motion and flexibility.

If these solutions are not sufficient in reducing the patient’s pain or increasing their shoulder strength, surgery may be recommended. Dr. Samuel Koo will often perform arthroscopic surgery to either remove the torn parts of the labrum, or reattach the torn parts using sutures. Patients will need to remain in a sling for 2 – 6 weeks following surgery and then attend regular physical therapy sessions. 

The specific course of treatment is based on the type of SLAP tear, the patient’s age, and their level of activity. No two cases are exactly alike, and so it is best to discuss your options with Dr. Samuel Koo when looking to repair an injury of the shoulder. Call (425) 823-4000 to schedule an appointment today.

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COVID-19 Update

4/21/20 Update: Effective immediately, Dr. Koo is seeing patients through telehealth visits and in-person visits at our clinic. Call today to schedule your appointment!

Dr. Samuel Koo is closely following the most up-to-date announcements and information on the known cases of Novel Coronavirus (COVID-19). Because this information is always changing, we will be monitoring all updated from the World Health Organization and Centers for Disease Control.

To better serve you, Dr. Koo is now proud to offer virtual visits. With telehealth, you can meet with Dr. Koo from the comfort and safety of your own home. Please call our office today to learn more about this service or to schedule an appointment.

As of last Friday the governor of Washington state issued a declaration that all non-urgent or emergent surgical cases be postponed until the week of May 18th. For more information, please reach out to our office at (425) 823-4000.

Here are a few additional resources as well:

World Health Organization
Centers for Disease Control