Signs of a SLAP Tear
SLAP tears present with deep shoulder pain during overhead activities, particularly during the late cocking and acceleration phases of throwing, often accompanied by mechanical symptoms like clicking or catching sensations in the shoulder. 1, 2
Clinical Presentation
Primary Symptoms
- Deep shoulder pain that is difficult to localize, typically located in the anterior or anterolateral aspect of the shoulder 1
- Pain specifically during overhead activities and throwing motions, most prominent during arm cocking and acceleration phases 1, 3
- Mechanical symptoms including clicking, popping, or catching sensations within the glenohumeral joint 2, 4
- Pain and weakness that may be mistaken for rotator cuff dysfunction or shoulder impingement 1, 5
Physical Examination Findings
- Focal weakness with decreased range of motion during abduction with external or internal rotation 1
- Pain during specific provocative maneuvers, though clinical diagnosis is notably difficult and unreliable 4, 6
- Signs may overlap with rotator cuff tendinopathy, making isolated clinical diagnosis challenging 1, 5
Associated Findings and Concurrent Injuries
Common Coexisting Pathology
SLAP tears frequently occur with other shoulder injuries that can confound the clinical picture:
- Partial undersurface rotator cuff tears, particularly of the supraspinatus and infraspinatus 1, 3
- Posterior capsular contracture and scapular dyskinesia in throwing athletes 3
- Cystic changes or marrow edema in the humeral head 4
- Hill-Sachs or Bankart lesions in cases with associated instability 4
- Capsular laxity contributing to secondary impingement 1
Important Clinical Context
- In throwing athletes, SLAP tears may be adaptive changes that are only occasionally symptomatic, making clinical correlation essential 3
- Skeletally immature throwers rarely develop SLAP lesions, as they more commonly present with rotator cuff dysfunction and secondary impingement from glenohumeral microinstability 1
- Up to 10% of rotator cuff tears are asymptomatic and present only with morphologic changes, highlighting that imaging findings must correlate with clinical symptoms 1
Diagnostic Imaging Approach
Initial Evaluation
- Standard three-view radiographs (AP in internal/external rotation and axillary or scapular-Y view) must be obtained first to rule out fractures and dislocations 7, 8
Definitive Imaging
- MR arthrography is the gold standard for SLAP tear diagnosis, with 86-100% sensitivity for detecting labral injuries 7, 9
- MR arthrography outperforms non-contrast MRI specifically for SLAP tears and anterior labral injuries 7
- CT arthrography is an appropriate alternative when MRI is contraindicated, reliably evaluating for SLAP tears and labroligamentous injuries 1, 7
Critical Pitfall
Non-contrast MRI has inferior sensitivity for SLAP tears compared to MR arthrography, particularly in chronic cases without adequate joint effusion for natural distention 9. The American College of Radiology emphasizes maintaining a low threshold for MR arthrography when SLAP tear is suspected clinically 1, 7.
Distinguishing SLAP from Other Labral Tears
SLAP tears specifically involve the superior labrum and biceps anchor, distinguishing them from other labral pathology 7:
- Bankart lesions result from anterior dislocations, cause recurrent instability, and do not involve the superior labrum 7, 9
- Posterior and inferior labral tears occur at different locations around the glenoid rim 7
- These injuries can coexist, with up to 10% of patients having both labroligamentous injury and glenoid bone loss 7