This narrative review synthesizes the pathophysiology, diagnosis, and treatment of SLAP lesions in overhead athletes. It addresses the cascade from posterior capsular tightness and scapular dyskinesis to the peel-back mechanism and type II SLAP tear. It covers physical exam limitations, MR arthrography as the imaging standard, conservative stretching protocols, and arthroscopic repair outcomes.
SLAP lesions in throwers fit a predictable cascade: years of overhead activity tighten the posterior IGHL, shift the glenohumeral center posterosuperiorly, and progressively load the biceps anchor with peel-back torsional force until the type II SLAP tears.
When a young pitcher or tennis player presents with posterior shoulder pain, loss of velocity, and clicking during the cocking phase, start with GIRD measurement and scapular examination before ordering MRI. If GIRD is present, a dedicated sleeper stretch and scapular stabilization program resolves symptoms in approximately 90% of patients — surgery is the exception, not the first step.
When you do image, order MR arthrography (not standard MRI); the greater than 90% sensitivity and specificity makes it the diagnostic standard for labral pathology. At arthroscopy, do not trust visual inspection alone — probe the biceps anchor and look for the peel-back sign in abduction and external rotation. A sublabral sulcus deeper than 5 mm demands repair, not dismissal as a normal variant.
Combined SLAP repair with rotator cuff repair or acromioplasty is safe and does not compromise outcomes, which matters when you encounter the common scenario of an older overhead athlete with mixed pathology.
This narrative review synthesizes the pathophysiology, diagnosis, and treatment of SLAP lesions in overhead athletes. It addresses the cascade from posterior capsular tightness and scapular dyskinesis to the peel-back mechanism and type II SLAP tear. It covers physical exam limitations, MR arthrography as the imaging standard, conservative stretching protocols, and arthroscopic repair outcomes.
SLAP lesions in throwers fit a predictable cascade: years of overhead activity tighten the posterior IGHL, shift the glenohumeral center posterosuperiorly, and progressively load the biceps anchor with peel-back torsional force until the type II SLAP tears.
When a young pitcher or tennis player presents with posterior shoulder pain, loss of velocity, and clicking during the cocking phase, start with GIRD measurement and scapular examination before ordering MRI. If GIRD is present, a dedicated sleeper stretch and scapular stabilization program resolves symptoms in approximately 90% of patients — surgery is the exception, not the first step.
When you do image, order MR arthrography (not standard MRI); the greater than 90% sensitivity and specificity makes it the diagnostic standard for labral pathology. At arthroscopy, do not trust visual inspection alone — probe the biceps anchor and look for the peel-back sign in abduction and external rotation. A sublabral sulcus deeper than 5 mm demands repair, not dismissal as a normal variant.
Combined SLAP repair with rotator cuff repair or acromioplasty is safe and does not compromise outcomes, which matters when you encounter the common scenario of an older overhead athlete with mixed pathology.