Labrum / SLAP repair

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus). — **Shoulder anatomy.** The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.

The glenoid labrum is a ring of fibrocartilage around the rim of the shoulder socket that deepens the joint and anchors the long head of the biceps. A SLAP tear — Superior Labrum Anterior-to-Posterior — involves the top of the labrum at the biceps anchor and typically occurs from repetitive overhead activity or a traction injury.

How the Procedure Works

The first decision is repair versus tenodesis — and it matters. In a thrower or overhead athlete under 30 with a clean type II SLAP and a healthy biceps tendon, we repair the labrum back to the glenoid rim with suture anchors, recreating the biceps anchor and restoring the labral bumper. In a patient over 35, a recreational athlete, or anyone with biceps tendon degeneration, the repair is unlikely to hold and often produces stiffness; in those cases a biceps tenodesis reliably eliminates the pain without depending on labral healing. When we do repair, the glenoid rim is freshened to bleeding bone, anchors are placed at the 12 o'clock and adjacent positions, and suture tension is set to re-seat the labrum at the rim without over-tightening — over-constraining the biceps anchor is what produces the loss of external rotation that ends throwing careers.

When to Consider Labrum / SLAP Repair

Labrum / SLAP repair is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:

Symptomatic type II SLAP tear in a young athlete
A tear causing deep shoulder pain with overhead activity in a patient still at the peak of their sporting career.
Mechanical symptoms
Catching or clunking with overhead motion that hasn't responded to therapy.
Failed non-operative care
A course of therapy and rest that has not returned the athlete to sport.