Labral Tear (SLAP Lesion)

The labrum is a ring of cartilage attached around the rim of the shoulder socket, deepening it and providing an anchor point for several important ligaments and the biceps tendon. A tear in this cartilage is a recognised cause of shoulder pain and, in some cases, instability.

A SLAP lesion, an acronym for superior labrum anterior to posterior, describes a specific tear pattern at the top of the labrum, close to where the biceps tendon attaches. This pattern is particularly associated with repetitive overhead activity, especially throwing sports.

Labral tears commonly result from repetitive overhead activity, such as throwing sports, swimming and racquet sports, where repeated stress on the shoulder gradually damages the labrum and its attachment to the biceps tendon. A fall onto an outstretched arm, or a sudden traction injury from lifting or pulling, can also cause a tear.

Degenerative wear of the labrum with age is another recognised pattern, occurring without a specific injury, particularly from the fourth or fifth decade of life onward.

Common symptoms of a labral tear include:

• Deep, sometimes poorly localised shoulder pain
• Pain that worsens with overhead activity or reaching behind the back
• A clicking, catching or popping sensation with certain movements
• A sense of the shoulder feeling loose or unstable in some cases
• Reduced throwing velocity or overhead performance in athletes

Because these symptoms overlap with several other shoulder conditions, imaging is often needed to confirm a labral tear specifically.

Assessment includes specific tests to reproduce labral symptoms, alongside an MRI, sometimes with contrast dye injected into the joint, to visualise the labrum and confirm the diagnosis and pattern of tear.

Non-surgical treatment is the starting point for most patients: physiotherapy focused on strengthening the rotator cuff and scapular muscles to support the shoulder, alongside activity modification and anti-inflammatory medication where appropriate.

For persistent symptoms that limit sport, work or daily activity, particularly in younger and more active patients, arthroscopic labral repair may be recommended, reattaching the torn labrum to the bone.

Many labral tears improve with a structured physiotherapy programme, particularly degenerative tears without significant instability. Where surgical repair is needed, outcomes are generally good, though overhead athletes, particularly throwers, should be aware that a full return to high-level throwing can take up to a year, given the demands placed on the repaired tissue.

Labral tears, including SLAP lesions, are a recognised cause of deep shoulder pain, particularly in overhead athletes, though they also occur from falls and general wear. Many improve with physiotherapy, and arthroscopic repair is available for persistent symptoms, particularly in younger, active patients. Deep shoulder pain with overhead activity, or a sense of instability, is worth having assessed.