SLAP tearMANAGEMENT

SHOULDER & CLAVICLE · 12 SECTIONS

⚲

472 items

☷ Legend

01Approach to the Critical Patient/attcp48

Triage and red flags

›Immediate priorities

›Hemodynamic instability

›Alternate diagnosis pathway

›Trauma activation criteria

›Open injury around shoulder

›Open fracture pathway

›Urgent orthopedics

›Neurovascular compromise

›Brachial pulse abnormality

›Hand ischemia signs

›Septic arthritis concern

›Fever

›Severe pain with minimal ROM

›Dislocation concern

›Visible deformity

›Axillary nerve deficit

Limb threat priorities

›Neurovascular status

›Axillary nerve

›Deltoid sensation

›Deltoid contraction

›Musculocutaneous nerve

›Lateral forearm sensation

›Elbow flexion strength

›Radial nerve

›Dorsal hand sensation

›Wrist extension strength

›Median nerve

›Palmar index sensation

›Thumb opposition strength

›Ulnar nerve

›Small finger sensation

›Finger abduction strength

›Vascular exam

›Radial pulse

›Capillary refill

›Documentation checkpoints

›Pre-immobilization neurovascular status

›Post-immobilization neurovascular status

Pain control and functional protection

›Early analgesia plan

›Acetaminophen first line when appropriate

›NSAID risk review

›Activity limitation

›Overhead lifting avoidance

›Throwing avoidance

›Early referral triggers

›Acute traumatic onset with overhead athlete

›Mechanical symptoms with failed conservative care

›Suspected biceps anchor detachment

02History/hx42

Mechanism and symptom pattern

›History core

›Mechanism

›Traction injury

›Fall on outstretched hand

›Direct blow to shoulder

›Repetitive overhead throwing

›Timing

›Acute traumatic

›Insidious overuse

›Symptom quality

›Deep shoulder pain

›Clicking or popping

›Catching or locking

›Night pain

›Location pattern

›Anterior shoulder pain

›Superior shoulder pain

›Posterior shoulder pain

›Aggravators

›Overhead activity

›Cross-body motion

›Push-ups or bench press

›Instability symptoms

›Apprehension episodes

›Subluxation history

Function and risk context

›Context

›Sport and position

›Throwing athlete

›Contact athlete

›Dominant arm

›Dominant side involvement

›Occupational overhead work

›Prior shoulder pathology

›Prior dislocation

›Prior rotator cuff injury

›Prior surgery

›Neurologic symptoms

›Neck pain

›Radiating arm pain

›Systemic infection risk

›IVDU

›Immunosuppression

03Physical Exam/exam59

Inspection and ROM

›Shoulder survey

›Deformity

›Dislocation pattern

›AC joint prominence

›Skin

›Ecchymosis

›Abrasion or laceration

›ROM

›Active ROM limitation

›Passive ROM limitation

›Scapular mechanics

›Scapular dyskinesis

›Winging

Provocative testing and associated injuries

›SLAP focused exam

›O’Brien active compression

›Pain or click in pronation

›Relief in supination

›Speed test

›Bicipital groove pain

›Weakness with resisted forward flexion

›Yergason test

›Bicipital groove pain with resisted supination

›Biceps tendon subluxation sensation

›Biceps load II

›Pain with resisted elbow flexion in abduction and external rotation

›Instability association

›Crank test

›Pain or click with axial load and rotation

›Mechanical symptoms reproduction

›Anterior slide

›Pain or click at anterior shoulder

›Symptom reproduction

›Rotator cuff screen

›Supraspinatus

›Empty can weakness

›Painful arc

›Infraspinatus and teres minor

›External rotation weakness

›Lag sign

›Subscapularis

›Lift-off abnormality

›Belly-press weakness

›Instability screen

›Apprehension and relocation

›Apprehension with abduction external rotation

›Relief with posterior force

›Sulcus sign

›Inferior laxity

›Multidirectional instability association

›AC joint screen

›Cross-body adduction pain

›AC tenderness

›Neurovascular

›Axillary nerve sensation

›Distal pulses

›PITFALLS

›Isolated exam test results low specificity for labral pathology

›Degenerative superior labral changes common in older adults

›Concomitant rotator cuff pathology common in older adults

04Differential Diagnosis/ddx35

Painful shoulder with clicking

›Key alternatives

›Rotator cuff tendinopathy or tear

›ICD-10 M75.1

›Weakness predominance

›Long head of biceps tendinopathy

›ICD-10 M75.20

›Bicipital groove tenderness

›Glenohumeral instability

›ICD-10 M25.31

›Apprehension episodes

›AC joint sprain or osteoarthritis

›ICD-10 S43.51

›Superior localized pain

›Subacromial impingement

›ICD-10 M75.4

›Painful arc

›Glenohumeral osteoarthritis

›ICD-10 M19.01

›Crepitus and stiffness

›Cervical radiculopathy

›ICD-10 M54.12

›Neck provocation signs

›Adhesive capsulitis

›ICD-10 M75.0

›Global passive ROM loss

Traumatic shoulder pain

›Traumatic alternatives

›Shoulder dislocation

›ICD-10 S43.0

›Deformity and ROM block

›Greater tuberosity fracture

›ICD-10 S42.25

›Pain with external rotation

›Bankart lesion

›Anteroinferior labral tear pattern

›Recurrent instability association

05Laboratory Tests/lt15

Routine labs

›Typical lab needs

›No routine labs for isolated suspected SLAP tear

›Baseline labs only for procedural sedation pathway

›Glucose if diabetes or altered intake

›Pregnancy test when applicable

Infection and inflammatory concern

›Septic arthritis or systemic illness pathway

›CBC for systemic infection concern

›Leukocytosis context dependent

›Normal CBC does not exclude infection

›CRP for inflammatory or septic concern

›Trend value greater than single value

›Elevated CRP nonspecific

›Blood cultures if febrile or septic

›Pre-antibiotic timing when feasible

›Negative cultures do not exclude septic arthritis

06Diagnostic Tests/dt51

Scoring Systems

›SLAP classification systems

›Snyder SLAP types

›Type I

›Superior labral fraying

›Biceps anchor intact

›Type II

›Biceps anchor detachment

›Unstable superior labrum

›Type III

›Bucket-handle labral tear

›Biceps anchor intact

›Type IV

›Bucket-handle tear into biceps tendon

›Biceps tendon involvement

›Clinical implication mapping

›Type I often nonoperative

›Type II often surgical consideration in young overhead athletes

›Type III often debridement consideration

›Type IV often biceps procedure consideration

Radiographs

›Initial imaging role

›Shoulder trauma screen

›AP

›Scapular Y

›Axillary view

›Alternative views

›Grashey true AP

›West Point view for instability suspicion

›Typical SLAP findings

›Normal radiographs common

›Rule-out fractures and dislocation priority

MRI

›MRI indications

›Persistent symptoms after conservative care

›High-demand overhead athlete with mechanical symptoms

›Preoperative planning pathway

›MR arthrogram

›Higher sensitivity than conventional MRI for labral pathology

›Contrast leakage between labrum and glenoid as tear sign

›Interpretation pearls

›Superior labral variants

›Sublabral recess mimic

›Buford complex mimic

›Age-related degenerative signal

›False positive risk in older adults

›Correlate with symptoms and exam

›CT role

›Bony lesion definition

›Glenoid bone loss suspicion

›Hill-Sachs characterization

›Surgical planning for instability patterns

›3D CT when bone loss concern

›Not first-line for isolated SLAP suspicion

07Disposition/dispo20

ED disposition

›Typical pathways

›Discharge with conservative plan when stable

›No neurovascular deficit

›No fracture or dislocation on imaging

›Urgent orthopedics or sports medicine referral

›Acute traumatic onset with functional loss

›Suspected shoulder instability

›Mechanical symptoms with occupational risk

›Same-day escalation

›Suspected dislocation not reduced

›Neurovascular deficit

›Open injury

›Septic arthritis concern

Follow-up timing

›Follow-up targets

›Primary care or sports medicine

›1 to 2 weeks for nontraumatic suspected labral injury

›Earlier if severe functional limitation

›Orthopedics

›3 to 7 days for traumatic injury with persistent pain or instability concern

›24 hours for neurovascular deficit or open injury

08Treatment/t100

Immediate life-saving interventions

›Time-critical exceptions

›Shoulder dislocation reduction pathway when present

›Reduction urgency with neurovascular compromise

›Post-reduction neurovascular re-check

›Septic arthritis pathway when present

›Early aspiration and antibiotics per local protocol

›Urgent orthopedics

Immobilization and Splinting

›Immobilization strategy

›Sling for comfort

›Short duration

›Early gentle ROM to prevent stiffness

›Avoid prolonged immobilization

›Stiffness risk

›Adhesive capsulitis risk

›Post-immobilization checks

›Neurovascular reassessment

›Pain reassessment

Reduction

›Reduction scope

›SLAP tear itself not reduced in ED

›Reduction only for associated dislocation

›Indications

›Neurovascular compromise

›Threatened skin

›Fracture-dislocation

›Analgesia and anesthesia options

›Non-opioid analgesia

›Acetaminophen PO 1000 mg q6h PRN

›Maximum 4000 mg per 24 hours

›NSAID options when appropriate

›Ibuprofen PO 400 mg q6h PRN

›Maximum 2400 mg per 24 hours

›Opioid titration when needed

›Morphine IV 0.05 mg/kg

›Repeat 0.025 mg/kg q10 min to effect

›Procedural sedation when required

›Monitoring and airway readiness

›Continuous pulse oximetry

›Continuous ECG

›Blood pressure q5 min

›Suction and BVM at bedside

›Ketamine IV 1 mg/kg

›Supplemental 0.25 mg/kg q5 to 10 min PRN

›Emergence mitigation per local protocol

›Propofol IV 0.5 mg/kg

›Supplemental 0.25 mg/kg q1 to 3 min PRN

›Hypotension risk monitoring

›Post-reduction requirements

›Post-reduction radiographs

›Immobilization in stable position

›Repeat neurovascular documentation

›Failed reduction pathway

›Irreducible dislocation urgent orthopedics

›Persistent neurovascular deficit immediate escalation

Open fracture medications and timing

›Open injury contingency

›Antibiotics per open fracture protocol when open fracture present

›Cefazolin IV 2 g

›Repeat dosing per local protocol

›Tetanus prophylaxis per immunization status

›Tdap when indicated

›TIG when indicated

›Urgent orthopedics and transfer criteria

›Open joint or fracture

›Gross contamination

DVT prophylaxis when relevant

›Typical need

›No routine pharmacologic prophylaxis for isolated upper extremity sling immobilization

›Consider prophylaxis only per institutional protocol in high-risk patients

›Active cancer

›Prior VTE

›Major trauma with reduced mobility

Nonoperative SLAP care

›Conservative management bundle

›Relative rest

›Avoid overhead lifting

›Avoid throwing

›Cryotherapy

›10 to 15 minutes

›Up to 3 to 5 times daily

›Analgesia

›Acetaminophen PO 1000 mg q6h PRN

›Maximum 4000 mg per 24 hours

›NSAIDs when appropriate

›Naproxen PO 500 mg initial

›Then 250 mg to 500 mg PO BID PRN

›Physical therapy focus

›Scapular stabilization

›Rotator cuff strengthening

›Posterior capsule stretching

›Expected timeline

›Symptom improvement over 6 to 12 weeks

›Return to throwing program after symptom control

Procedural options and surgical considerations

›Specialist-directed options

›Intra-articular corticosteroid injection

›Diagnostic and therapeutic trial in select cases

›Infection and glycemic risk counseling

›Operative pathways

›Arthroscopic debridement for Type I pattern

›SLAP repair consideration in young overhead athletes with Type II pattern

›Biceps tenodesis consideration in older patients or failed repair risk

›Evidence framing

›Nonoperative care first-line for most nontraumatic SLAP presentations (Class I recommendation)

›Surgical decision driven by age, athlete status, tear type, and concomitant pathology (Class IIa recommendation)

09Special Populations/sp33

Pregnancy

›Pregnancy considerations

›Imaging safety

›Radiographs acceptable with shielding when clinically indicated

›MRI without gadolinium preferred when advanced imaging needed

›Analgesia

›Acetaminophen preferred

›NSAIDs avoidance in later pregnancy

›Positioning during exam and procedures

›Left lateral tilt in later pregnancy when supine symptoms

›Hypotension monitoring

Geriatric

›Geriatric considerations

›Degenerative labral changes common

›MRI false positive risk

›Symptom correlation priority

›Concomitant rotator cuff pathology common

›Weakness and ROM pattern integration

›Ultrasound consideration in specialist setting

›Treatment emphasis

›PT and function-first plan

›Lower threshold for adhesive capsulitis prevention with early ROM

›Surgical selection

›Higher failure risk of SLAP repair

›Consider biceps tenodesis over repair in selected patients (Class IIa recommendation)

Pediatrics

›Pediatric considerations

›True SLAP tears less common than instability patterns

›Bankart association with dislocation

›Growth plate injury rule-out in trauma

›Imaging

›Radiographs prioritized after trauma

›MRI reserved for persistent symptoms with specialist input

›Rehabilitation

›Activity restriction guidance for sports

›Gradual return to play program

10Background/b36

Epidemiology

›Frequency patterns

›Higher prevalence in overhead athletes

›Throwers and swimmers

›Volleyball and tennis

›Degenerative superior labral signal common with aging

›Incidental MRI findings common

›Symptoms not always attributable to labrum

›Concomitant pathology common

›Rotator cuff tendinopathy overlap

›Instability overlap

Pathophysiology

›Anatomy and mechanism

›Superior labrum and biceps anchor complex

›Long head of biceps insertion at superior labrum

›Peel-back mechanism in abduction external rotation

›Injury mechanisms

›Traction injury on arm

›Compression with fall on outstretched hand

›Repetitive overhead microtrauma

›Symptom generation

›Labral instability with mechanical symptoms

›Biceps anchor inflammation with anterior pain

Therapeutic Considerations

›Nonoperative rationale

›Symptom drivers often multifactorial

›Scapular dyskinesis contribution

›Posterior capsule tightness contribution

›PT improves biomechanics and load distribution

›Scapular control reduces peel-back stress

›Rotator cuff strength improves humeral head centering

›Operative rationale

›Unstable biceps anchor tears in high-demand athletes

›Repair aims to restore labral stability

›Tenodesis offloads biceps-labrum complex

›Evidence levels

›MRI and MR arthrogram performance varies by protocol and interpreter (ACEP Level C)

›Composite exam plus imaging plus response to rehab improves diagnostic confidence (Class I recommendation)

›Tenodesis favored over repair in many older populations due to outcomes and revision rates (Class IIa recommendation)

11Patient Discharge Instructions/pdi26

Copy discharge instructions

›Discharge packet

›Diagnosis explanation

›Suspected superior labral injury with biceps anchor involvement

›Confirmatory testing often outpatient

›Activity and protection

›Sling for comfort only

›Avoid overhead lifting

›Avoid throwing until cleared

›ROM guidance

›Gentle pendulum exercises if tolerated

›Avoid painful end-range positions

›Pain plan

›Acetaminophen dosing instructions

›NSAID dosing instructions when appropriate

›Ice and swelling

›Ice 10 to 15 minutes

›Up to 3 to 5 times daily

›Follow-up plan

›Sports medicine or orthopedics within 1 to 2 weeks

›PT referral if available

›Return to ED now

›New numbness or weakness in arm or hand

›Cold or pale hand

›Severe worsening pain

›Fever with severe shoulder pain

›New visible deformity

12References/r7

Guidelines and evidence sources

›Reference set

›American Academy of Orthopaedic Surgeons shoulder guidelines and appropriate use criteria

›American Shoulder and Elbow Surgeons consensus statements on labral and biceps pathology

›National Athletic Trainers’ Association position statements on overhead athlete shoulder injury

›Society of American Shoulder and Elbow Therapists rehabilitation principles for shoulder labral pathology

›ACEP clinical policy on procedural sedation in the ED for associated reduction needs (ACEP Level B)

›ATLS principles for associated trauma evaluation and imaging prioritization

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed March 6, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.