Movement Medicine

SLAP Tears in Throwers

Eric Nichols
Apr 29, 2025By Eric Nichols

What Is a SLAP Tear?
The glenoid labrum is a fibrocartilaginous rim that deepens the shoulder socket, providing stability. A SLAP tear involves damage to the top "superior" part of the labrum where the long head of the biceps tendon anchors.

SLAP tears are classified into several types, but in throwers, Type II tears: detachment of the biceps anchor, are the most common.

Throwing results in extreme tensile forces on the biceps anchor during:

  • Late cocking phase (max external rotation)
  • Early acceleration (rapid internal rotation)

Over time, these forces can cause microtrauma, eventual detachment, and significant instability or pain.

Frequency and Risk Factors in Baseball
SLAP tears account for up to 12% of all shoulder injuries in overhead athletes (Wilk et al., 2013) and are particularly common in high school, collegiate, and professional pitchers.

Risk factors include:

  • Repetitive overhead throwing stressing the superior labrum
  • High pitch counts and year-round competition
  • Poor scapular control and rotator cuff weakness
  • Limited hip and thoracic mobility, increasing stress on the shoulder
  • History of prior shoulder injuries (especially internal impingement)

A 2011 study by Erickson et al. showed that throwers who log high velocity or frequent sliders/curveballs are at greater risk of developing labral pathology.

Signs and Symptoms
Symptoms can be subtle at first but progressively worsen with continued throwing:

  • Deep, aching pain in the posterior or superior shoulder
  • Pain during late cocking or follow-through phases of throwing
  • Clicking, popping, or catching sensations in the shoulder
  • Loss of throwing velocity or control
  • Dead arm feeling during or after games
  • Decreased shoulder strength or endurance
  • Athletes may initially describe "just feeling off" before more pronounced symptoms emerge.

Diagnosis and Imaging
Diagnosis requires a combination of:

  • Sports Med PT Exam: Strength, Range of Motion, Special Tests
  • History: Noting pain during throwing phases, mechanical symptoms, or previous shoulder instability.
  • Sports Med MD Exam: MRI with contrast (MR arthrogram): Gold standard imaging to confirm labral tears and biceps involvement.
  • Dynamic ultrasound is occasionally used for adjunct evaluation is not as accurate for labral tears compared to MR arthrogram.

Treatment
Non-surgical management is often attempted first:

Phase 1: Acute Management (0–4 Weeks)

  • Rest from throwing
  • Pain management (ice, NSAIDs as appropriate)
  • Restore scapular control and pain-free range of motion
  • Avoid aggressive biceps loading early on

Phase 2: Targeted Rehabilitation (4–12 Weeks)

  • Rotator cuff and scapular strengthening (focus on posterior cuff)
  • Core stability and lower kinetic chain strength training
  • Gradual introduction of isometric and eccentric biceps work
  • Address posterior capsule tightness with stretching and mobility work

Phase 3: Return-to-Throwing Preparation (12–16 Weeks)

  • Plyometric training (e.g., medicine ball throws, rebounder drills)
  • Progressive return-to-throwing program
  • Emphasis on efficient kinetic chain mechanics to reduce shoulder load


Surgical Considerations
If symptoms persist despite 3–4 months of conservative treatment—or in cases of large, unstable tears—surgery may be considered.Consult your Sports Medicine Physician for Surgical options.

Rehab
Postoperative rehab typically requires 6–9 months before return to competitive throwing.

Return to Sport Timelines
Return to sport varies depending on severity and treatment:

  • Non-surgical management: Approximately 4–6 months for full return 
  • Post-surgical repair: Approximately 9–12 months for full throwing progression


Return-to-sport success rates vary:

  • Non-operative rehab: 50–70% success in throwers (Wilk et al., 2013)
  • SLAP repair surgery: Only 60–68% of professional pitchers return to previous levels (Smith et al., 2016)


Contributing factors

  • Persistent posterior capsule tightness and scapular dyskinesis increase risk
  • Failure to fully restore kinetic chain efficiency (hips, core, scapula) places recurrent stress on the superior labrum
  • Returning too early or without a structured throwing progression raises reinjury rates

Prevention Strategies

  • Consistent arm care routine/shoulder maintenance programs focusing on rotator cuff and scapular health
  • Posterior capsule stretching to improve shoulder mobility
  • Hip and thoracic mobility drills to reduce shoulder overload
  • Monitor pitch counts, especially with breaking ball-heavy pitchers
  • Gradual throwing ramp-up protocols each preseason

Summary

SLAP tears represent a major challenge for baseball throwers, impacting performance and career longevity. However, with early diagnosis, aggressive but smart rehabilitation, and careful return-to-throwing strategies, many players can successfully return to the mound.

A holistic approach addressing the entire kinetic chain, not just the shoulder, is the key to successful outcomes.

SLAP tears represent a major challenge for baseball throwers, impacting performance and career longevity. However, with early diagnosis, aggressive but data driven rehabilitation, along with a structured progressive return-to-throwing program, many players can successfully return to throwing.

A holistic approach by addressing the entire kinetic chain, not just the shoulder, is the key to successful outcomes. 

We provide this holistic approach by utilizing motion capture and force-plate technology to thoroughly analyze each athlete. Using this data to design individualized performance and rehab programs. Resulting in elite performance and outcomes. 


 
References
1. Wilk KE, et al. (2013). Current concepts in the rehabilitation of the overhead throwing athlete. The American Journal of Sports Medicine, 41(2): 419–430.

2. Erickson BJ, et al. (2011). SLAP lesions in the overhead athlete: current treatment options. Current Reviews in Musculoskeletal Medicine, 4(2): 63–67.

3. Smith MV, et al. (2016). Return to throwing after superior labral anterior-posterior (SLAP) repair in overhead athletes: A systematic review. Journal of Shoulder and Elbow Surgery, 25(7): 1172–1176.

4. Sayde WM, et al. (2012). Return to play after type II superior labral anterior-posterior repairs in athletes: a systematic review. Arthroscopy, 28(10): 1385–1392.

5. Neri BR, et al. (2011). Outcomes of shoulder surgery in professional baseball players. Arthroscopy, 27(5): 625–631.