The superior labral complex encompasses the superior glenoid labrum, the biceps-labral complex at the biceps anchor, and the superior glenohumeral ligament (SGHL) attachment at the superior labrum. SLAP tears (Superior Labral tears from Anterior to Posterior) involve disruption of the biceps anchor and/or the superior labrum, classified into Types I-IV (Snyder), with Type II (biceps anchor detachment from the glenoid) being the most clinically significant and surgically treated lesion.
The superior labrum deepens the glenoid concavity superiorly; the biceps anchor (biceps-labral complex) provides the long head biceps a secure attachment preventing superior migration; the SGHL contributes to inferior translation resistance in the adducted arm.
SLAP tears are common in overhead athletes (throwers, swimmers, racquet sports) from traction on the biceps anchor during the deceleration phase of throwing. The active compression test (O'Brien) and the dynamic labral shear test have moderate sensitivity and specificity. MRI arthrogram is the investigation of choice, demonstrating the biceps anchor detachment. Type II SLAP repair (arthroscopic suture anchor fixation of the biceps-labral complex to the glenoid rim) provides good outcomes in young athletes; in patients over 35, biceps tenodesis may be preferred to SLAP repair given better functional outcomes and faster recovery.
Biceps anchor detachment from the superior glenoid rim (Type II SLAP) from the traction-compression mechanism of the throwing deceleration phase produces deep shoulder pain in late cocking and follow-through; MRI arthrogram demonstrates contrast tracking under the superior labrum and detachment of the biceps anchor; arthroscopic suture anchor repair restores the anchor in the young throwing athlete.
