Superior labral anterior posterior tear

Dr Dan J Bell and A.Prof Frank Gaillard et al.

Superior labral anterior posterior (SLAPtears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. 

SLAP tears involve the superior glenoid labrum, where the long head of biceps tendon inserts. Unlike Bankart lesions and ALPSA lesions, they are uncommonly (20%) associated with shoulder instability 5.

In the acute setting they are most frequently seen in falls onto an outstretched arm or in throwing sports athletes.

The most widely used system for classification of SLAP tears was originally described by Snyder 7. On the basis of arthroscopic findings, four patterns of injury were originally described: 

  • type I: fraying of the superior labrum
  • type II: detachment of the superior labrum and biceps anchor from the underlying superior glenoid
  • type III: bucket handle tear of the superior labrum without extension into the long head of biceps tendon
  • type IV: bucket handle tear of the superior labrum with extension into the long head of biceps tendon

Beyond these four classes, multiple additional types have been described, although their clinical relevance is controversial.  Other described types include 6:

  • type V: anterior-inferior Bankart lesion in continuity with a type II SLAP lesion
  • type VI: combination of a type II SLAP lesion and an unstable labral flap either anterior or posterior
  • type VII: type II SLAP lesion with extension to the capsule and the middle glenohumeral ligament (MGHL)
  • type VIII: type IIB SLAP lesion with posterior labral extension
  • type IX: complete or almost complete circumferential detachment of the labrum from the glenoid
  • type X: superior labral tear in combination with extension to the rotator cuff interval or the superior glenohumeral ligament or the coracohumeral ligament

The investigation of choice is an MR arthrogram, which is variably reported as having accuracies of 75-90%, although distinguishing between subtypes can be difficult 2.

High signal (fluid on T2WI or arthrographic contrast on T1WI) is seen extending into the superior labrum, and tracking into the labrum, and sometimes into the biceps tendon is the characteristic finding.

  • type I tears are usually asymptomatic and do not require treatment
  • type II tears require surgical reattachment
  • type III tears usually require resection of the bucket handle tear 2
  • sublabral sulcus: SLAP type II tears can appear similar to a normal sublabral sulcus or normal glenoid articular hyaline cartilage which extends beneath the labrum; the following features help distinguish a tear from the latter two 1,2
    • high T2 signal or contrast curves laterally
    • high signal width within labrum >2 mm
    • high signal or contrast extends posterior to biceps anchor 
    • double Oreo cookie sign
  • sublabral foramen: SLAP tear type II, in which the labrum is avulsed from the underlying glenoid can look similar to a sublabral foramen (a variant of normal), but can be distinguished from the latter by observing high signal extending between the glenoid and labrum posterior to the attachment of the biceps tendon
  • Buford complex
    • normal anatomical variant in which there is congenital absence of the labrum between the 1-3 o'clock positions
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Article information

rID: 2127
Synonyms or Alternate Spellings:
  • Superior Labral Anterior Posterior tear
  • SLAP lesion
  • SLAP tear
  • SLAP lesions
  • SLAP tears

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Cases and figures

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    Case 5: ALPSA, SLAP 2 tear, and GAGL
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