Labrum Tear / SLAP Tear
Shoulder Labrum Tears (SLAP & Bankart Tears) in Houston
The shoulder is the most mobile joint in the body—a tradeoff for that mobility is reduced inherent stability. The shoulder socket (glenoid) is shallow and relies on a combination of soft-tissue structures to keep the ball of the humerus in place. The most important of these is the labrum, a ring of fibrocartilage that lines the rim of the socket. The labrum deepens the socket, anchors the ligaments that prevent dislocation, and serves as the attachment point for the long head of the biceps tendon at the top of the joint.
How Labrum Tears Happen
The labrum is vulnerable to two main mechanisms of injury:
- Acute traumatic injury, most commonly a shoulder dislocation. When the ball pops out of the socket, it typically tears the labrum off the front-lower portion of the rim. This injury pattern is called a Bankart tear and is the most common labral tear in young patients.
- Repetitive overhead use, particularly in baseball pitchers, swimmers, volleyball players, and other overhead athletes. Repeated stress at the top of the labrum, where the biceps tendon attaches, can cause a SLAP tear (Superior Labrum from Anterior to Posterior).
A fall onto an outstretched arm, a forceful pull, or weightlifting injuries can also cause labral tears.
Types of Labral Tears
Labral tears are named by their location around the socket:
- SLAP tears involve the upper (superior) labrum, where the biceps tendon attaches. SLAP tears are subdivided into types based on the pattern of injury.
- Bankart tears involve the anterior-inferior labrum and are typically caused by anterior shoulder dislocation. A bony Bankart tear (Bankart fracture) involves a piece of the socket bone as well.
- Posterior labral tears involve the back of the socket and can cause posterior instability—often seen in football linemen, weightlifters, and patients who have had a posterior dislocation.
- Circumferential or complex tears involve more than one region and may require more extensive repair.
Symptoms
Symptoms depend on the location and severity of the tear and may include:
- Deep, aching shoulder pain, often worse with overhead activity
- Clicking, catching, or popping with shoulder motion
- A sense that the shoulder is slipping, sliding, or "going to come out"
- Recurrent dislocations or near-dislocations
- Decreased strength, particularly in throwing or pushing motions
- Decreased throwing velocity in overhead athletes
- Pain at night or with specific arm positions
Diagnosis
A careful history typically suggests the diagnosis—a prior dislocation, a history of overhead athletics, or a sense of instability. Physical examination uses specific provocative tests (such as the apprehension and relocation tests, the O'Brien's test, and the load-and-shift test) to identify the location of the tear and the type of instability.
Imaging includes:
- X-rays to evaluate for associated bony injury (a Hill-Sachs lesion on the humerus or a bony Bankart on the socket)
- MRI, often with intra-articular contrast (MR arthrogram), which provides the most accurate non-invasive assessment of labral integrity
Non-Surgical Treatment
Many labral tears, particularly SLAP tears in older patients or partial tears without instability, respond well to non-operative treatment:
- Activity modification (especially avoiding the provocative position)
- Physical therapy focused on rotator cuff strengthening, scapular stabilization, and posterior capsular stretching
- Anti-inflammatory medication
- Selective corticosteroid injections in some cases
For young patients with traumatic Bankart tears and a first-time dislocation, the recurrence rate without surgery is high—particularly in athletes under age 25—which often pushes the decision toward earlier surgical stabilization.
Arthroscopic Labral Repair
Arthroscopic labral repair is the standard surgical treatment for symptomatic tears that have failed non-operative care or for patients with recurrent instability. The procedure is performed through three to four small incisions, each under a quarter-inch:
- A camera (arthroscope) is placed into the shoulder joint to identify the tear and assess associated injuries.
- The bone surface where the labrum will be reattached is gently prepared to encourage healing.
- Specialized suture anchors—small implants embedded in the bone—are placed along the rim of the glenoid.
- Sutures from the anchors are passed through the torn labrum and tied to reattach it firmly to its anatomic position.
The number and configuration of anchors depends on the tear size and pattern. In some cases of significant bone loss, a bony procedure (such as a Latarjet procedure or bone grafting) may be needed instead of or in addition to soft-tissue repair.
Recovery After Labral Repair
Recovery is staged to protect the repair while motion and strength are progressively restored:
- Weeks 0–6: Sling immobilization to protect the repair. Pendulum exercises and supervised passive motion in physical therapy.
- Weeks 6–12: Progressive active range of motion. Strengthening begins selectively.
- Months 3–6: Progressive strengthening of the rotator cuff and surrounding muscles. Return to non-contact activities.
- Months 4–6+: Return to overhead activity and contact sport based on shoulder strength and functional testing. Throwers typically require a structured return-to-throw program over additional months.
Over 90% of appropriately selected patients return to their prior activity without recurrent instability after Bankart repair.
Further patient education is available in this handout.
Scheduling Your Visit
Appointments for shoulder instability and labral tear evaluation are scheduled through UTHealth Houston at 713-486-1700. The practice has offices in Memorial Villages and the Texas Medical Center.
Frequently asked questions
What is a shoulder labrum tear?
The labrum is a ring of cartilage that deepens the shoulder socket (glenoid) and helps stabilize the joint. A labral tear is a disruption of this rim of cartilage, typically caused by injury such as a dislocation, or by repetitive overhead activity in throwers and overhead athletes.
What is the difference between a SLAP tear and a Bankart tear?
Both are types of labral tears in different locations. A SLAP tear (Superior Labrum from Anterior to Posterior) involves the top of the labrum where the biceps tendon attaches. A Bankart tear is a tear of the anterior-inferior labrum, typically caused by a shoulder dislocation, and is the most common labral tear pattern in young athletes.
What symptoms does a labrum tear cause?
Symptoms vary by location but commonly include deep shoulder pain, clicking or catching with motion, pain with overhead activity, a sense of the shoulder slipping or being unstable, and decreased strength in throwing or pushing motions.
How is a labral tear diagnosed?
Diagnosis combines a careful history, physical examination, and imaging. MRI—often with intra-articular contrast (MR arthrogram)—is the most accurate non-invasive test for confirming a labral tear. X-rays evaluate for associated bony injury.
Can a labral tear heal without surgery?
Many labral tears improve with physical therapy, particularly in older patients or in those without recurrent instability. Surgery is more often recommended in younger or athletic patients with recurrent dislocations, throwing athletes with persistent symptoms, or patients with mechanical symptoms despite non-operative care.
What is involved in arthroscopic labral repair?
Through three to four small incisions, suture anchors are placed into the bone of the glenoid socket and sutures are passed through the torn labrum to reattach it firmly to its anatomic position. The procedure is performed arthroscopically on an outpatient basis.
How long is recovery after labral repair?
Most patients wear a sling for approximately 4 weeks. Motion progresses through the next several weeks, and strengthening begins as the sling is discontinued. Sports-related rehabilitation begins around 3 months, with return to throwing around 4–5 months, mound throwing or contact sports around 6 months, and full recovery generally by 12 months.
What are the success rates of labral repair surgery?
For appropriately selected patients with traumatic Bankart tears, over 90% return to their prior activity level without recurrent instability. Results in SLAP repairs and complex labral patterns depend on age, activity, and specific tear characteristics.