Is a Labrum Tear the Same as a SLAP Injury?
No, a SLAP tear is a specific type of labrum tear, not synonymous with all labrum tears—SLAP specifically refers to Superior Labrum Anterior to Posterior tears involving the biceps anchor, while labral tears can occur anywhere around the glenoid rim.
Understanding the Distinction
The glenoid labrum is a ring of fibrocartilage that surrounds the entire shoulder socket. Tears can occur at any location around this structure 1:
- SLAP tears are a specific subset of labral injuries that begin posteriorly in the superior labrum and extend anteriorly, stopping before or at the mid-glenoid notch, and critically involve the biceps tendon anchor 2
- Other labral tears include Bankart lesions (anterior-inferior labrum), posterior labral tears, and inferior labral tears that do not involve the superior labrum or biceps anchor 1, 3
SLAP Tear Classification
SLAP lesions have four main types (I-IV) with six extended variants (V-X) 4:
- Type I: Superior labral fraying at the biceps anchor region 5
- Type II: Superior labral fraying with stripping of the labrum and biceps off the glenoid fossa—the most common type requiring surgical consideration 6, 5
- Type III: Bucket-handle tear of the superior labrum at the biceps anchor 5
- Type IV: Bucket-handle tear extending into the proximal biceps tendon itself 3, 5
Clinical Implications of the Distinction
The differentiation matters significantly for management 1, 7:
- SLAP tears typically result from compression forces (fall on outstretched arm) or repetitive overhead microtrauma, presenting with pain during overhead activities and painful catching or popping 4, 2
- Bankart lesions result from anterior shoulder dislocations and cause recurrent instability 1
- These injuries can coexist—up to 10% of patients with recurrent instability have both labroligamentous injury and glenoid bone loss 1
Diagnostic Approach
MR arthrography is the gold standard for all labral pathology, with 86-100% sensitivity for detecting labral injuries 1, 7:
- Standard three-view radiographs (AP internal/external rotation plus axillary or scapula-Y) must be obtained first to rule out fractures and dislocations 1, 7
- MR arthrography outperforms non-contrast MRI specifically for SLAP tears and anterior labral injuries 1
- For acute dislocations, non-contrast MRI may be preferred over MR arthrography 7
Common Pitfall
Do not assume all shoulder labral pathology is the same—the location, mechanism, associated injuries, and treatment algorithms differ substantially between SLAP tears and other labral injuries like Bankart lesions, requiring accurate diagnosis for appropriate management 1, 6, 2.