Biceps and SLAP tears

Biceps and labrum anatomy

The labrum is a rim of cartilage that deepens the shoulder socket. The long head of the biceps anchors near its upper edge. A SLAP tear affects this superior labrum from front to back; biceps tendinopathy affects the tendon itself. These problems can occur together or with a rotator cuff tear.

How symptoms develop

A fall on an outstretched arm, forceful traction, heavy lifting, or repetitive throwing can injure the biceps-labral complex. In many adults, gradual tissue wear is part of the picture. Clicking alone is common and does not necessarily mean that treatment is needed.

Evaluation

The examination looks at the biceps groove, labrum, rotator cuff, shoulder stability, motion, and the neck. X-rays assess bone and arthritis. MRI or MR arthrography may help define the labrum and associated tendon injury, but imaging findings must match the symptoms and examination.

Nonsurgical care

• Temporarily modify painful lifting or overhead activity
• Anti-inflammatory medication when medically appropriate
• Physical therapy for motion, rotator cuff strength, and shoulder-blade control
• A carefully selected diagnostic or therapeutic injection when appropriate

When surgery is considered

Surgery may be discussed when a clearly identified biceps or labral problem continues to limit function after an appropriate rehabilitation program. Options can include labral repair, biceps tenodesis, or biceps tenotomy. The choice depends on tissue quality, age, sport or work demands, cosmetic concerns, and other shoulder findings.

Recovery

Recovery varies by procedure. A repaired labrum or tenodesis must be protected while tissue heals, followed by progressive motion and strengthening. Return to forceful lifting or throwing is gradual and usually takes several months.