Understanding SLAP Tears: Why Your Shoulder Pain Might Be More Than Just a Strain

What Is a SLAP Tear?

SLAP stands for Superior Labrum Anterior to Posterior. This refers to an injury of the top part of your shoulder's labrum—the ring of cartilage that stabilizes your shoulder socket. It's also where the biceps tendon attaches, which is why SLAP tears often present like biceps tendon pain.

Common Causes of SLAP Tears

• Falling on an outstretched arm

• Repetitive overhead motions (throwing, pressing, swimming)

• Heavy lifting or sudden jerking movements

• Direct trauma (sports, accidents)

Signs and Symptoms

• Deep, dull pain at the top or front of the shoulder

• Clicking, catching, or popping sensation

• Pain during mid-range overhead movements (90–100°)

• Painful and weak "full can" test, but normal "empty can"

• Symptoms that improve when lying down or when scapula is supported

Real Patient Story: Active Adult With a History of Labrum Surgery

A 58-year-old male, active lifestyle (also does crossfit), reported:

• Recurring anterior shoulder pain

• History of labrum surgery from a similar injury 10 years ago

• Aggravation during pull-ups, push-ups, and overhead pressing

• Pain that worsens between 90–100° of shoulder flexion

• Shoulder felt significantly better when lying down (scapular support)

After several visits, the biggest discoveries included:

• Thoracic spine stiffness and poor rotation

• Overactive upper traps and underactive serratus anterior

• Recurrent trigger points that resisted soft tissue work

• Pain that dramatically reduced when stability and motor control were restored

Conservative Treatment Approach

You don’t always need surgery. Many SLAP tears can be rehabbed successfully by addressing contributing factors.

Key Elements of SLAP Rehab:

• Thoracic spine mobility: Extension and rotation are critical for overhead capacity

• Scapular control: Teaching proper serratus and lower trap activation

• Motor control: Reprogramming patterns like overhead lifts or rotational movements

• Progressive loading: Gradually returning to pressing and pulling without symptom reproduction

• Functional alignment: Aligning rehab with sport or lifestyle goals

When to Get an MRI or Ortho Consult

While rehab is effective, there are times when imaging helps:

• Persistent weakness despite good rehab

• Locking or mechanical symptoms

• Previous surgery + new trauma

• Patient preference for clarity or peace of mind

In our case example, an MRI confirmed:

• Small SLAP tear

• Supraspinatus tendinopathy

• AC joint degeneration

Still, the patient was cleared for conservative care by the orthopedic physician, reinforcing our plan.

Final Takeaways

SLAP tears can mimic a lot of other shoulder issues. The key is:

1. Accurate diagnosis (clinical tests + movement observations)

2. Clear communication with patients about goals and expectations

3. Treatment that restores movement, stability, and control

Shoulder pain doesn’t have to mean surgery. With the right approach, even stubborn SLAP-related symptoms can improve and get you back to full activity.

Struggling with shoulder pain? Don’t ignore it. Get assessed and start a rehab plan that works for you.