We discussed what happened to the end of the biceps tendon if it completely tears off from the cup or the glenoid. Now what happens if you get a tear at the end of the biceps where it attaches to the glenoid via the labrum? Let’s look at the anatomy for a second and then we will discuss SLAP (Superior Labrum Anterior Posterior) tears.
The end of the biceps attaches to the labrum which attaches to the glenoid as seen here. It serves as the anchor for the biceps muscle, so it is very important for lifting things from the ground, i.e. cleans, farmer’s carry, deadlifts. Imagine a weight pulling down on your arm and the rotator cuff, biceps, and all the other shoulder stabilizer muscles resisting that force and contracting to keep your arm from being pulled down.
There are things called traction injuries where the arm is pulled suddenly from the socket. One example of such an injury is what I often will call Big Dog Traction injuries (not Big Dawg). It comes from people who have large dogs and when those dogs pull violently after seeing another dog, squirrel or postal worker, they yank the leash that is attached to the person’s hand and pain develops from the traction of the biceps and labrum pulling off the glenoid.
Getting back to CrossFit stuff, can you imagine that the same traction type injury that can occur with that initial moment of pulling on a deadlift, if you are not using proper form and technique? So, it is important not to pull at the weights and yank away but to keep your whole shoulder girdle locked in with straight arms and shoulders back squeezing your scapula or shoulder blades together. Then with your arms extended and solid, initiate the lift with your legs not your upper body. If you do not have proper form and rotate your shoulders forward, you are eliminating the scapular stabilizers or the muscles located in the back of your shoulders (another topic for later) and putting more strain on your structures in the front of the shoulder like your biceps.
The other important point for this topic is to stay in line with your progression. Yes, we see unbelievable changes in conditioning and strength at CrossFit, but please don’t think this is an exponential curve once you are comfortable with the movements. I think there is a tendency for new people to start looking at the leader boards checking the records and saying to themselves “I can get that tomorrow or the next day” as opposed to staying in control and gradually work up their progression of weight. Don’t get me wrong unleashing the Dogs of Fury is great and fun, but I just want people to unleash the Dogs as opposed to be getting pulled by the leash.
The other main way that people can develop SLAP tears are from abduction external rotation stresses as in pitching, volleyball, and pull-ups. Look at the tremendous amount of what is called external rotation that occurs in the shoulder of this pitcher when he throws.
In the shoulder joint the biceps tendon and labrum are rotating back and doing what is called “peeling back” or lifting off the glenoid or socket. See the biceps tendon/labrum on top of the glenoid peeling back away from the glenoid as the arm is rotated externally as it does in a throwing motion.
Now look at the Kipping pull-up picture below, pretty similar.
So this brings us to the question, “Are we all destined to develop SLAP tears?” NO. What can we do about it? Stay tuned- next installment how to prevent SLAP tears and what happens if you have one.
D Sean Rockett, M.D., is an orthopedic surgeon and senior partner of 
I had surgery on my labrum 8 months ago and still feel pinching pain when I lift my arm up and sideways. Feels like I need to pop my shoulder or push the shoulder blade back. My pinky finger is numb and hand feels very tired could my surgery have failed?
need more info, what surgery was performed? were tears seen at time of surgery? when did numbness start?
Hi. I have been an athlete all my life and been doing crossfit for almost 3 years now. Had a slap repair in April. I have been having a lot if mobility issues. I have so much stiffness and cramping/pain along my neck, shoulder, lats, rhomboids, traps that not a whole lot seems to help. I have tried so many different stretches to loosen all of this. The doc says ” oh just keep stretching”. I am at a loss of what may be going on?
What may be happening is that scar developed before you were able to regain complete mobility and you developed a frozen shoulder. Typically it does loosen up with stretching. Sometimes a release is helpful if does not improve.
One last thing that came to me, is it possible the sling I am wearing could be responsible for these symptoms. Thanks again.
Dr., I recently had surgery to repair a tear of the Labrum in my right shoulder. Everything appears to be progressing relatively well, however I have a fairly significant amount of discomfort in my left shoulder that’s feels very similar to how the right one felt prior to the procedure. I noticed a fairly substantial popping sensation in the back of my shoulder when I reach across my body. This seems to occur frequently. Additionally, I noticed some pain on the top of the shoulder and a minor amount occasionally in the front. On one particular day, I noticed a significant degree of soreness near the front of the shoulder that ran down into the bicep and some numbness in my fingers. I also noticed a minimal amount of clicking when I hold my arm out to the side parallel to the ground and I raise the arm up. Long story short, I fear I may have a tear in the left shoulder. Given that I had surgery on the right about three weeks ago, if the left is also torn, what would be the earliest you would recommend having the left repaired? Obviously, I wouldn’t be able to have the procedure on the left until I had some reasonable level of functional use of the right. Thanks in advance.
Lots of things can be happening if you are feeling clicking, I would be happy to see you. Sean
Hi Sean,
Hopefully you can give me a little feedback. I hurt my shoulders 3 weeks ago doing a snatch. Long story short, I caught the bar well past my head behind me. I heard no pop and it really didnt hurt at all. My shoulders hurt for a few days afterwards at the top of the shoulders and the side a little. My right tricep also hurt a little. My shoulders have gotten better but I hear random pops every now and then, no pain. I have full ROM too. Doing planks causes pain at the top of my shoulders. 3 weeks after injury my triceps still hurts a bit and now my bicep also hurts a little. The pain is minimal though, 2 out of 10 I would say. Any idea what I may have going on? I saw my doctor and he didnt seem to think it was anything major but I just dont know, something doesnt feel right.
good and informatory post..
keep up the good work..
http://millsteinorthopedics.com/conditions/shoulder-injuries/slap-tear/
Hi Sean, I live on the westcoast, so it’s a little hard to come to your office 🙂 I would appreciate any feedback you can give me.
I injured my right shoulder in late april when I caught a snatch very far behind me. The pain in in the front center of the shoulder. With ice, rest, ibuprofen, the day to day pain went away, but I still can not OHS or snatch without a significant amount of pain. Saw an ortho and the took an x-ray… and gave me a cortizone shot in late june. I spend 15-20min everyday on mobility work and have good shoulder mobility. Last week I pushed for an MRI and the results came back:
1. Partial-thickness tear at the inferior surface of the distal
right supraspinatus tendon involving 50% of the tendon width.
2. Superio-anterior right glenoid labral tear.
3. Degenerative changes of the right acromioclavicular joint with
inferior osteophytes compressing onto the musculotendinous
junction of the right supraspinatus.
4. Cystic degenerative changes of the posterior right humeral head.
I have very good strength straight overhead infact strict press has gone up. Aything with a wide grip such as OHS or Snatch is very painfull. Dips are also painfull.
What are your thoughts on surgery?
If I don’t get surgery, what should I be doing and what should I NOT be doing?
I am 33years old.
Thank you very much for your time.
-Tony
So you have a partial thickness rotator cuff tear and a SLAP tear. The SLAP will most likely continue to bother you for overhead activities. It comes down to either modifying and avoiding painful situations or get it fixed and take the 4-6 months to recover. Surgery is successful for these and I usually recommend it for people that have failed a trial of conservative management with modifying. Does that help? Sean
Yes it does, thanks.
Can you put your arm strait out to your side and raise it above your head. If you can do that then it is not your rooattr cuff. May have pulled some muscle. I don’t think it’s gall bladder related.
It is a common misconceptioon that as long as you can lift your arm, your rotator cuff is fine. The cuff can still have issues with normal motion.
great explanation. I was ripping/jerking the bar up in my 1RM DL to get a little momentum into the bar, and being coached not to. now I can see why.
HiIf it IS referred pain from the galdbladler, I would assume the shoulder pain would be associated with eating a meal containing fats.You might want to keep a journal of what you have eaten just before it becomes most painful.If it turns out to be your galdbladler, take a breath and consider the non-surgical approaches to managing it. Too many people are frightened into rapidly removing this organ that has a definite function in the body.I hope this helps some!Good luck!
Thanks for the info.
I currently have a slap tear and can’t wait to read your next article!
my name is i got shoulder ditiocaslon problem, after meet the doctor at government hospital the say my shoulder ligament is tear ,but i do want do the surgery ,can i do Platelet-Rich Plasma (PRP) Therapy to became my shoulder back normal again and my tear shoulder ligament can back to normal again,can help me doctor
I would say PRP is not indicated for a chronically loose shoulder.
Doc…I have a small tear in my labrum. Is PRP an option for that type of small tear?
Yes we can try it. The published reports for tendonitis and PRP are better than they are for healing SLAP tears
Thanks Doc…since I’m already your patient I’ll be calling the office next week : )
Might as well give it a shot