SLAP tear (superior labral tear)

What it is

The socket of the shoulder is shallow, and a rim of cartilage called the labrum deepens it and gives the ligaments something to attach to. The long head of the biceps tendon anchors into the top of that rim. A SLAP tear is a tear of the labrum at the top, at or around that biceps anchor. It ranges from simple fraying to an anchor that has lifted off the bone.

How volleyball causes it

Volleyball produces these two ways. The common one is slow: in maximal external rotation the biceps anchor twists and peels the top of the labrum backwards off the bone, a fraction at a time, across thousands of cocking phases, which is why it usually turns up alongside internal impingement and a tight posterior shoulder. The other is a single event, such as landing on an outstretched arm out of a dive, bracing against a hard driven ball, or a block deflection that yanks the arm sideways. Beach players collect more of the traumatic version because of the landings, indoor players more of the wear version because of the hitting volume.

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What it feels like

• Deep pain inside the shoulder that you cannot point to with one finger. Players describe it as being behind everything
• Clicking, catching, or popping when the arm goes overhead or across the body
• Pain in the arm back position and again at ball contact, with a sense that the shoulder is loose or not connected
• Pulling and curling feel weak or sore, because the biceps anchor is involved
• Loss of arm speed with no obvious weak muscle when someone tests you
• Symptoms that rise and fall with how much you hit and never fully clear

Stop and get it seen if

• The shoulder slipping partly out of joint, or giving way when the arm is up and back.
• A distinct pop at the moment of a fall or a caught arm, followed by immediate weakness or inability to lift the arm.
• The shoulder locking so the arm will not move through its normal range.
• Numbness or pins and needles down the arm, or a hand that feels weak.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Settling and confirming

   2 to 6 weeks

   Reduce provocation and get an actual diagnosis, since a SLAP tear is very hard to tell apart from internal impingement or a cuff problem by feel alone

   • Rest pain and night pain settling
   • Overhead reach available without a catch
   • A clinician has examined the shoulder and there is a plan
   • Symptoms clearly tied to specific positions rather than everything

2. 2. Building stability around it

   6 to 12 weeks

   Get the muscular control good enough that the joint does not depend on the torn rim, which is often enough to play on

   • Cuff and blade strength matched side to side
   • Clicking reduced, or present but no longer painful
   • Overhead loading tolerated without symptoms
   • No sense of the shoulder shifting under load

3. 3. Return to overhead volume

Ready to play again when

• Full swings at competitive effort with no catching, no painful clicking, and no sense of the shoulder shifting
• Symmetric cuff strength and no pain on resisted biceps loading
• Two or three full hitting sessions in a week with no delayed reaction
• Confidence to attack a tight set that forces a full reach back

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Keep internal rotation with daily cross body and sleeper stretches, because a tight posterior shoulder increases the peel back twist on the labrum.
• Cuff and scapular endurance work such as side lying external rotation, prone Y raises and band rows, so control does not vanish in the fourth set.
• Drill diving and rolling in defence instead of catching yourself on a straight arm. Beach players in particular should practise shoulder rolls out of a full extension dig.
• Train the biceps and forearm in normal strength work. A stronger biceps anchor tolerates the peel back load better.
• Manage total hitting volume across a week and a season, which is the lever with the most evidence behind it for the wear version of this injury.