High Yield Overview

SLAP TEARS

Superior Labrum Anterior to Posterior | Biceps Anchor | Type II Critical

Type IIClinically significant

LHBAnchor detached

OverheadAthletes at risk

VariableRepair vs tenotomy

SLAP CLASSIFICATION (Snyder)

Type I

PatternFraying, degenerative

TreatmentDebridement only

Type II

PatternBiceps anchor detached

TreatmentRepair or biceps procedure

Type III

PatternBucket handle tear

TreatmentExcision, preserve anchor

Type IV

PatternBucket handle into biceps

TreatmentExcise + repair or tenotomy

Critical Must-Knows

Type II is the CLINICALLY SIGNIFICANT SLAP tear - biceps anchor is detached
O-Brien test and Speed test are key provocative tests
Overhead athletes (throwers) are high-risk population
SLAP repair outcomes declining in literature - tenotomy/tenodesis rising
Age over 40: consider biceps tenotomy/tenodesis over SLAP repair

Examiner's Pearls

"
MR arthrography is gold standard for SLAP diagnosis
"
Peel-back test: arthroscopic confirmation (ABER position)
"
High failure rate of SLAP repair in throwing athletes
"
Type II can be subdivided: anterior, posterior, combined

Clinical Imaging

Imaging Gallery

Global labral (SLAP IX) tear in a 24-year-old male athlete with a 10-month history of right shoulder pain. Axial (a) fat suppressed T1-weighted MR arthrography and (b) corresponding axial CT arthrogra — Global labral (SLAP IX) tear in a 24-year-old male athlete with a 10-month history of right shoulder pain. Axial (a) fat suppressed T1-weighted MR artCredit: Jarraya M et al. via Insights Imaging via Open-i (NIH) (Open Access (CC BY))

Bucket-handle SLAP tear (Type 3) with Perthes lesion in a 23-year-old male athlete with a one-month history of right shoulder pain after a fall onto outstretched arm. a Coronal and c axial fat-suppres — Bucket-handle SLAP tear (Type 3) with Perthes lesion in a 23-year-old male athlete with a one-month history of right shoulder pain after a fall onto oCredit: Jarraya M et al. via Insights Imaging via Open-i (NIH) (Open Access (CC BY))

SLAP tear type IV in a 20-year-old goalkeeper after a fall onto fully abducted right shoulder with immediate pain. Coronal (a) fat-suppressed T1-weighted MR arthrography and (b) corresponding coronal — SLAP tear type IV in a 20-year-old goalkeeper after a fall onto fully abducted right shoulder with immediate pain. Coronal (a) fat-suppressed T1-weighCredit: Jarraya M et al. via Insights Imaging via Open-i (NIH) (Open Access (CC BY))

SLAP tear type V with rotator cuff lesion in a 38-year-old male athlete with right shoulder pain. a Coronal and c axial fat-suppressed T1-weighted MR arthrography and correspondent b coronal and d axi — SLAP tear type V with rotator cuff lesion in a 38-year-old male athlete with right shoulder pain. a Coronal and c axial fat-suppressed T1-weighted MR Credit: Jarraya M et al. via Insights Imaging via Open-i (NIH) (Open Access (CC BY))

Critical Exam Concepts

Type II is KEY

Type II SLAP = biceps anchor detached. This is the clinically significant lesion. Types I and III can be debrided. Type IV involves biceps tendon itself.

Overhead Athletes

Throwers have posterosuperior SLAP tears from peel-back mechanism in late cocking. Often associated with GIRD (glenohumeral internal rotation deficit) and posterior capsular tightness.

SLAP Repair Declining

Recent literature shows high failure rates of SLAP repair, especially in patients over 40. Trend toward biceps tenotomy or tenodesis with comparable outcomes and faster recovery.

Age Matters

Under 40: Consider SLAP repair in motivated patient. Over 40: Biceps tenotomy or tenodesis preferred. Degenerative labral changes common over 40.

Quick Decision Guide

SLAP Type	Pathology	Treatment	Role of Biceps
Type I	Degenerative fraying	Debridement only	Anchor intact - leave
Type II	Biceps anchor detached	Repair or biceps procedure	Anchor must be addressed
Type III	Bucket handle tears	Excise bucket handle	Anchor intact - leave
Type IV	Bucket handle into biceps	Excise +/- repair or tenotomy	Biceps tendon involvement
Type V-X	Combined lesions	Address each component	Variable - case dependent

Mnemonic

FBBBSLAP Classification

Fraying

Type I - degenerative fraying

Biceps anchor detached

Type II - most important

Bucket handle

Type III - displaced labrum

Biceps tendon split

Type IV - bucket into biceps

Memory Hook:FBBB - Know Type II (Biceps anchor) is the KEY clinical SLAP!

Mnemonic

SOAPSLAP Clinical Tests

Speed test

Resisted forward flexion with extended elbow

O-Brien test

Forward flexion, adduction, IR then ER

Anterior slide

Hand on hip, forward/upward force

Peel-back sign

Arthroscopic ABER detachment

Memory Hook:SOAP up the shoulder tests for SLAP diagnosis!

Mnemonic

AGESLAP Repair vs Biceps Procedure Decision

Age under 40

Consider SLAP repair if motivated

Gross biceps pathology

Tenotomy/tenodesis if tendon degenerative

Expectations

Throwers may not return to prior level

Memory Hook:AGE guides SLAP repair vs biceps procedure decision!

Overview and Epidemiology

Declining SLAP Repair Rates

SLAP repairs peaked then declined in the 2000s-2010s as studies showed high failure rates, especially in patients over 40 and throwers. Trend now toward biceps tenotomy or tenodesis which provides reliable pain relief with faster recovery.

Epidemiology

Originally described in 1990 (Snyder)
Peak age 26-50 years
Male greater than female
Overhead athletes overrepresented
Increasing diagnosis with MRI/arthroscopy

Mechanism

Compression: Fall on outstretched hand, arm forward and abducted
Traction: Sudden pulling force on arm
Peelback: Throwing motion (late cocking) in throwers
Degenerative: Age-related in Type I
Repetitive overhead: Cumulative microtrauma

Pathophysiology and Mechanisms

Superior Labral Anatomy

Location: 10 o-clock to 2 o-clock position on glenoid.

Biceps anchor: LHB tendon inserts at supraglenoid tubercle, blending with superior labrum.

Meniscoid appearance: Less firmly attached than anterior labrum - may appear loose on arthroscopy.

Blood supply: Relatively avascular zone (10-12 o-clock) - limits healing.

Distinguish SLAP from Normal Variants

Sublabral foramen (absent anterosuperior labrum) and Buford complex (cord-like MGHL) are normal variants that should NOT be repaired. True SLAP tears show: fraying, instability of biceps anchor, extension toward biceps, and positive peel-back test.

Classification Systems

Original Snyder Classification (Types I-IV)

Type	Pathology	Treatment	Key Point
I	Fraying of superior labrum	Debridement	Anchor intact - no repair
II	Biceps anchor detached from glenoid	Repair or biceps procedure	MOST IMPORTANT clinically
III	Bucket handle tear of labrum	Excise bucket handle	Anchor intact - preserve it
IV	Bucket handle extending into LHB	Excise +/- repair/tenotomy	Biceps tendon split

Clinical Assessment

History

Mechanism: Compression, traction, throwing
Pain: Anterior/deep shoulder, with overhead activity
Clicking/popping: Common complaint
Sport level: Overhead athlete critical
Weakness: May report with overhead activity

Examination

O-Brien test: Pain with forward flex/adduct/IR, relieved with ER
Speed test: Resisted forward flexion
Anterior slide: Hand on hip, force applied
Biceps load test: ABER with biceps contraction
GIRD: Check internal rotation deficit

O-Brien Test (Active Compression Test)

Arm at 90° forward flexion, 10-15° adduction, thumb down (IR). Resist downward pressure. Then repeat with palm up (ER). Positive: Pain with IR, relieved with ER. Most commonly used clinical test for SLAP.

Key Examination Findings

Overhead athletes: Check for GIRD (internal rotation deficit greater than 20° compared to opposite side), posterior capsular tightness, scapular dyskinesis.

Combined pathology: SLAP tears often associated with rotator cuff pathology - assess thoroughly.

Investigations

MR Arthrography (Gold Standard)

Sensitivity: 82-98% for Type II SLAP.

Technique: Intra-articular gadolinium increases labral visualization.

Key findings: Contrast extension between labrum and glenoid at superior labrum.

ABER sequence: Increases sensitivity for peel-back lesions.

Superior to standard MRI for labral pathology.

Peel-Back Test

Arthroscopic ABER positioning: With arm in abduction and external rotation (throwing position), the biceps vector becomes vertical and peels the posterosuperior labrum off the glenoid. Positive peel-back = Type II SLAP (especially IIB in throwers).

Management Algorithm

SLAP Type-Based Treatment

Decision Pathway

Type IDebridement

Degenerative fraying. Anchor intact. Simple debridement of frayed tissue. No repair needed.

Type IIRepair or Biceps Procedure

Biceps anchor detached. Options: SLAP repair (under 40, motivated), biceps tenotomy (over 40, low demand), or tenodesis (over 40, active).

Type IIIExcision

Bucket handle tear. Anchor intact. Excise the displaced bucket handle fragment. Preserve the anchor.

Type IVExcise and Decision

Bucket handle into biceps. If less than 30% biceps involvement: excise bucket handle. If greater than 30%: biceps tenotomy or tenodesis.

Surgical Technique

Arthroscopic SLAP Repair

Surgical Steps

Step 1Diagnostic Arthroscopy

Confirm SLAP classification. Perform peel-back test. Assess biceps tendon quality.

Step 2Preparation

Debride frayed tissue. Decorticate glenoid rim to bleeding bone. Mobilize the labrum.

Step 3Anchor Placement

1-3 suture anchors at superior glenoid rim. Place at 10-11 o-clock and 12-1 o-clock. Avoid suprascapular nerve on superior anchor.

Step 4Labral Repair

Pass sutures through labrum. Tie to restore labral bumper and biceps anchor stability.

Anchor Positioning

Avoid placing anchors too posterior (risk suprascapular nerve at spinoglenoid notch) or too medial on glenoid neck (inadequate purchase). Anchors should be on the glenoid rim at the articular margin.

Complications

Complication	Procedure	Incidence	Management
Stiffness	SLAP repair	Common	Aggressive PT, avoid in throwers
Failure/recurrence	SLAP repair	20-40%	Revision or biceps procedure
Popeye deformity	Tenotomy	30-70%	Cosmetic - counsel preop
Nerve injury	Repair	Rare	Avoid superior/posterior anchor
Persistent pain	Any	Variable	Address all pathology, consider revision

SLAP Repair Failure in Throwers

Overhead throwing athletes have 33-64% failure rate after SLAP repair in some studies. The peel-back forces during throwing stress the repair. Many surgeons now recommend biceps tenotomy/tenodesis for throwers with Type II SLAP.

Postoperative Care

Rehabilitation Protocol (SLAP Repair)

Week 0-4Protection Phase

Sling immobilization. Elbow/hand exercises. Gentle pendulums only. No active biceps.

Week 4-8Early Motion

Wean sling. Passive to active-assisted ROM. Avoid ABER position. No resisted biceps.

Week 8-12Active ROM

Full AROM. Isometric cuff strengthening. Begin light biceps activity.

Month 3-6Strengthening

Progressive resistance. Sport-specific training. No throwing until 6 months minimum.

Tenotomy/Tenodesis Recovery

Biceps procedures have faster recovery. Tenotomy: sling 1-2 weeks, no restrictions by 6 weeks. Tenodesis: protect biceps 6 weeks, no heavy biceps loading 3 months. Both return to full activity faster than SLAP repair.

Outcomes and Prognosis

Procedure-Specific Outcomes

SLAP Repair: 60-80% good outcomes overall. Higher failure rate in throwers (33-64%), patients over 40, and workers compensation. Stiffness is common concern.

Biceps Tenotomy: 85-95% pain relief. Popeye deformity in 30-70%. Minimal strength loss for daily activities.

Biceps Tenodesis: Similar pain relief to tenotomy. Lower cosmetic deformity rate. Preferred in younger/active/cosmetically concerned patients.

Return to Sport

SLAP repair: 6-9 months for non-throwing sports. Throwing athletes may take 9-12 months with variable return to prior level.

Biceps procedures: Often faster return (3-4 months).

Evidence Base and Key Studies

SLAP Repair Declining Outcomes

Erickson BJ et al. • Am J Sports Med (2016)

Key Findings:

Database study of SLAP repairs 2004-2014
Peak in 2008 then declining numbers
Shift toward biceps tenodesis
Reflects disappointing clinical outcomes of repair

Clinical Implication: SLAP repair rates declining due to poor outcomes - biceps procedures rising.

Limitation: Database study, lacks clinical detail.

SLAP Repair in Throwers

Gilliam BD et al. • Am J Sports Med (2018)

Key Findings:

Systematic review of SLAP repair in overhead athletes
63% return to preinjury level
37% failure/did not return to sport
Posterior capsular tightness associated with failure

Clinical Implication: High failure rate of SLAP repair in throwing athletes.

Limitation: Heterogeneous studies, variable follow-up.

Tenotomy vs Tenodesis

Hsu AR et al. • J Shoulder Elbow Surg (2011)

Key Findings:

Meta-analysis comparing tenotomy and tenodesis
Similar pain relief (greater than 85% both)
Tenotomy: 43% Popeye deformity
Tenodesis: 8% Popeye deformity

Clinical Implication: Tenodesis preferred when cosmesis important; functional outcomes similar.

Limitation: Meta-analysis of mostly retrospective studies.

Age and SLAP Outcomes

Provencher MT et al. • Am J Sports Med (2013)

Key Findings:

Multicenter study of SLAP repairs
Age over 36: poorer outcomes
50% failure rate in patients over 40
Associated pathology worsens outcomes

Clinical Implication: Age over 40 favors biceps procedure over SLAP repair.

Limitation: Retrospective, selection bias possible.

SLAP Classification Reliability

Snyder SJ et al. • Arthroscopy (1990)

Key Findings:

Original description of SLAP lesions
Types I-IV defined
Type II most clinically significant
Foundation for current classification

Clinical Implication: Snyder classification remains the standard for SLAP lesions.

Limitation: Original descriptive study, observer variability exists.

Exam Viva Scenarios

Practice these scenarios to excel in your viva examination

VIVA SCENARIOStandard

Scenario 1: Young Athlete with Shoulder Pain

EXAMINER

"A 28-year-old recreational volleyball player presents with right shoulder pain during overhead serving. O-Brien test is positive. MR arthrography shows a Type II SLAP lesion with intact biceps tendon. How would you manage this?"

EXCEPTIONAL ANSWER

This is a Type II SLAP tear - the clinically significant SLAP lesion where the biceps anchor is detached from the glenoid. My initial management would include confirming the examination findings and ensuring no other pathology is present. Given her age (under 40), recreational (not elite) sport level, and intact biceps tendon, I would discuss treatment options. Conservative management could be attempted first: relative rest, NSAIDs, and physical therapy focusing on rotator cuff strengthening and addressing any posterior capsular tightness. If conservative treatment fails after 3-6 months, I would recommend arthroscopic SLAP repair. At surgery, I would confirm the diagnosis with peel-back test, prepare the glenoid rim, and place 1-2 suture anchors to repair the detached labrum and biceps anchor. Postoperatively, she would be in a sling for 4 weeks, followed by progressive ROM and strengthening. Return to volleyball would be at 6-9 months. I would counsel her that SLAP repair has variable outcomes (60-80% success) and if her primary goal is pain relief, biceps tenodesis is an alternative with potentially faster recovery.

KEY POINTS TO SCORE

Type II SLAP = biceps anchor detached

Trial conservative treatment first

SLAP repair reasonable in under 40, motivated patient

Counsel on variable outcomes

Biceps procedure is alternative option

COMMON TRAPS

✗Jumping to surgery without conservative trial

✗Not distinguishing Type II from other SLAP types

✗Over-promising SLAP repair outcomes

✗Not assessing for associated pathology

LIKELY FOLLOW-UPS

"What if she were 45 years old?"

"What is the peel-back test?"

"What are normal anatomical variants at superior labrum?"

VIVA SCENARIOChallenging

Scenario 2: Failed SLAP Repair

EXAMINER

"A 35-year-old had SLAP repair 18 months ago but has persistent anterior shoulder pain with overhead activities. MRI shows the repair appears intact. What is your approach?"

EXCEPTIONAL ANSWER

This is persistent pain after SLAP repair, which occurs in 20-40% of cases. My approach would be systematic. First, I would re-evaluate the diagnosis - are there other pain generators? I would examine for rotator cuff pathology, acromioclavicular joint pathology, and cervical spine referral. I would review the MRI for subtle cuff tears or biceps tendinopathy within the groove. I would also ask about the character of pain and whether it matches preoperative symptoms. Assuming the SLAP repair is intact and there is no other identifiable pathology, the persistent pain may be due to: 1) Stiffness/capsular tightness from the repair, 2) Subclinical repair failure not visible on MRI, or 3) The labral pathology was not the primary pain source. If physical therapy has been exhausted, I would consider diagnostic arthroscopy. At arthroscopy, I would assess the repair (may show subtle failure), probe for instability, and examine the biceps in its groove. If the repair is intact but the biceps tendon shows tendinopathy, I would recommend biceps tenodesis. Cutting out the biceps from the repair and fixing it distally often provides reliable pain relief. This salvage procedure has good outcomes for failed SLAP repairs.

KEY POINTS TO SCORE

20-40% failure rate after SLAP repair

Rule out other pain generators

Biceps tenodesis is effective salvage procedure

MRI may not show subtle repair failure

Consider diagnostic arthroscopy if unclear

COMMON TRAPS

✗Assuming repair failure without evaluation

✗Missing concurrent pathology (cuff, AC joint)

✗Repeating SLAP repair (high failure rate)

✗Not considering biceps contribution to pain

LIKELY FOLLOW-UPS

"What is the advantage of subpectoral tenodesis?"

"What if the biceps tendon is completely degenerative?"

"What outcomes can you quote for biceps tenodesis?"

VIVA SCENARIOCritical

Scenario 3: Throwing Athlete

EXAMINER

"A 22-year-old elite baseball pitcher has posterior shoulder pain during the cocking phase of throwing. MR arthrography shows a posterosuperior Type IIB SLAP tear. Examination also reveals 25° GIRD. What is your treatment plan?"

EXCEPTIONAL ANSWER

This is a classic throwing athlete presentation - posterior Type IIB SLAP from peel-back mechanism during late cocking, with associated GIRD (glenohumeral internal rotation deficit) indicating posterior capsular contracture. This is one of the most challenging shoulder problems to treat. My approach would begin with aggressive non-operative management. The GIRD must be addressed first with sleeper stretches and cross-body stretching to restore internal rotation. Physical therapy would focus on posterior capsular flexibility, rotator cuff strengthening, and scapular stabilization. I would counsel him that SLAP repairs in throwers have high failure rates (33-64% in some studies) and many pitchers do not return to their preinjury level. If conservative treatment fails after 3-6 months, surgical options include: 1) SLAP repair - but with guarded prognosis given the peel-back forces in throwing; 2) SLAP repair with posterior capsular release - to address the GIRD component; or 3) Biceps tenodesis - increasingly favored given poor SLAP repair outcomes in throwers. I would have an honest discussion with him about the possibility that he may not return to elite-level pitching regardless of treatment choice. Some surgeons now prefer early biceps tenodesis in throwing athletes with SLAP tears.

KEY POINTS TO SCORE

Type IIB SLAP = posterior, from peel-back in throwers

GIRD indicates posterior capsular tightness

Address GIRD with stretching before/with surgery

High failure rate of SLAP repair in throwers

Biceps tenodesis increasingly favored

COMMON TRAPS

✗Recommending SLAP repair without counseling on poor outcomes

✗Not addressing GIRD

✗Overpromising return to elite performance

✗Rushing to surgery without conservative trial

LIKELY FOLLOW-UPS

"What is the peel-back mechanism?"

"How would you address GIRD surgically?"

"What is your preferred biceps procedure and why?"

MCQ Practice Points

Type II SLAP

Q: Which SLAP type is the most clinically significant? A: Type II - biceps anchor is detached from the glenoid. This requires surgical treatment (repair or biceps procedure). Types I and III can usually be debrided.

Type I Treatment

Q: How is a Type I SLAP treated? A: Debridement only. Type I is degenerative fraying with intact biceps anchor. No repair is needed - simply debride the frayed tissue.

Peel-Back Test

Q: What does a positive peel-back test indicate? A: Type II SLAP tear (especially Type IIB). In ABER position, the biceps vector becomes vertical and peels the posterosuperior labrum off the glenoid.

O-Brien Test

Q: How is the O-Brien test performed? A: Arm at 90° forward flexion, 10-15° adduction, thumb down (IR). Resist downward pressure. Repeat with palm up (ER). Positive: pain with IR, relieved with ER.

Sublabral Foramen

Q: What is the sublabral foramen? A: Normal anatomical variant - detachment of anterosuperior labrum at 1-3 o-clock position. Should NOT be repaired. Distinguished from SLAP by stable biceps anchor.

Age and SLAP Repair

Q: Why is SLAP repair less recommended in patients over 40? A: 50% failure rate in patients over 40. Degenerative labral/biceps changes reduce healing. Biceps tenotomy or tenodesis preferred for reliable pain relief.

Australian Context

Clinical Practice

Arthroscopic SLAP repair available
Trend toward biceps procedures increasing
MR arthrography standard for diagnosis
Sports medicine specialists manage overhead athletes
Conservative management emphasized initially

Funding and Access

MR arthrography accessible
Rehabilitation readily available
Wait times variable in public system
Private covers most shoulder surgery

Orthopaedic Exam Relevance

SLAP tears are a common viva topic. Know the Snyder classification (especially Type II), clinical tests (O-Brien, peel-back), and the trend toward biceps tenotomy/tenodesis. Be prepared to discuss treatment in overhead athletes and why outcomes are variable.

SLAP TEARS

High-Yield Exam Summary

Classification (Snyder I-IV)

•Type I: Fraying - debride only
•Type II: Biceps anchor detached - MOST IMPORTANT
•Type III: Bucket handle - excise, anchor intact
•Type IV: Bucket into biceps - excise +/- tenotomy

Clinical Tests (SOAP)

•Speed test: Resisted forward flexion
•O-Brien test: Forward flex/adduct/IR vs ER
•Anterior slide: Hand on hip, force applied
•Peel-back: Arthroscopic ABER position

Type II Decision Factors

•Under 40: Consider SLAP repair
•Over 40: Biceps tenotomy or tenodesis
•Throwing athlete: High failure rate - consider tenodesis
•Degenerative biceps: Tenotomy or tenodesis

Imaging

•MR arthrography: Gold standard
•Look for contrast at labral-glenoid junction
•ABER sequence increases sensitivity
•Peel-back test confirms at arthroscopy

Outcomes

•SLAP repair: 60-80% success overall
•Throwers: 33-64% may fail
•Tenotomy: 85-95% pain relief, Popeye 30-70%
•Tenodesis: Similar relief, less cosmetic deformity

Normal Variants (Do NOT repair)

•Sublabral foramen (1-3 o-clock)
•Buford complex (cord-like MGHL)
•Meniscoid labrum (loose attachment)
•Distinguish by stable biceps anchor

SLAP Type

Pathology

Treatment

Role of Biceps

Type I

Degenerative fraying

Debridement only

Anchor intact - leave

Type II

Biceps anchor detached

Repair or biceps procedure

Anchor must be addressed

Type III

Bucket handle tears

Excise bucket handle

Anchor intact - leave

Type IV

Bucket handle into biceps

Excise +/- repair or tenotomy

Biceps tendon involvement

Type V-X

Combined lesions

Address each component

Variable - case dependent

Type

Pathology

Treatment

Key Point

Fraying of superior labrum

Debridement

Anchor intact - no repair

Biceps anchor detached from glenoid

Repair or biceps procedure

MOST IMPORTANT clinically

III

Bucket handle tear of labrum

Excise bucket handle

Anchor intact - preserve it

Bucket handle extending into LHB

Excise +/- repair/tenotomy

Biceps tendon split

Arthroscopic SLAP Repair

Surgical Steps

Step 1Diagnostic Arthroscopy

Confirm SLAP classification. Perform peel-back test. Assess biceps tendon quality.

Step 2Preparation

Debride frayed tissue. Decorticate glenoid rim to bleeding bone. Mobilize the labrum.

Step 3Anchor Placement

1-3 suture anchors at superior glenoid rim. Place at 10-11 o-clock and 12-1 o-clock. Avoid suprascapular nerve on superior anchor.

Step 4Labral Repair

Pass sutures through labrum. Tie to restore labral bumper and biceps anchor stability.

Anchor Positioning

Avoid placing anchors too posterior (risk suprascapular nerve at spinoglenoid notch) or too medial on glenoid neck (inadequate purchase). Anchors should be on the glenoid rim at the articular margin.

Complication

Procedure

Incidence

Management

Stiffness

SLAP repair

Common

Aggressive PT, avoid in throwers

Failure/recurrence

SLAP repair

20-40%

Revision or biceps procedure

Popeye deformity

Tenotomy

30-70%

Cosmetic - counsel preop

Nerve injury

Repair

Rare

Avoid superior/posterior anchor

Persistent pain

Any

Variable

Address all pathology, consider revision

SLAP Tears

SLAP Tears

SLAP TEARS

SLAP CLASSIFICATION (Snyder)

Critical Must-Knows

Examiner's Pearls

Clinical Imaging

Imaging Gallery

Critical Exam Concepts

Type II is KEY

Overhead Athletes

SLAP Repair Declining

Age Matters

Quick Decision Guide

FBBBSLAP Classification

SOAPSLAP Clinical Tests

AGESLAP Repair vs Biceps Procedure Decision

Overview and Epidemiology

Epidemiology

Mechanism

Pathophysiology and Mechanisms

Superior Labral Anatomy

Long Head of Biceps Attachment

Normal Variants

Distinguish SLAP from Normal Variants

Classification Systems

Original Snyder Classification (Types I-IV)

Type II Subdivisions

Types V-X (Maffet et al.)

Clinical Assessment

History

Examination

O-Brien Test (Active Compression Test)

Key Examination Findings

Investigations

MR Arthrography (Gold Standard)

Standard MRI

Diagnostic Arthroscopy

Management Algorithm

SLAP Type-Based Treatment

Decision Pathway

Type II SLAP Decision Tree

Non-Operative Management

Surgical Technique

Arthroscopic SLAP Repair

Surgical Steps

Anchor Positioning

Arthroscopic Biceps Tenotomy

Biceps Tenodesis

Complications

Postoperative Care

Rehabilitation Protocol (SLAP Repair)

Tenotomy/Tenodesis Recovery

Outcomes and Prognosis

Procedure-Specific Outcomes

Return to Sport

Evidence Base and Key Studies

SLAP Repair Declining Outcomes

SLAP Repair in Throwers

Tenotomy vs Tenodesis

Age and SLAP Outcomes

SLAP Classification Reliability

Exam Viva Scenarios

Scenario 1: Young Athlete with Shoulder Pain

Scenario 2: Failed SLAP Repair

Scenario 3: Throwing Athlete

MCQ Practice Points

Australian Context

Clinical Practice

Funding and Access

SLAP TEARS

Classification (Snyder I-IV)

Clinical Tests (SOAP)

Type II Decision Factors

Imaging

Outcomes

Normal Variants (Do NOT repair)

SLAP Tears

SLAP Tears

SLAP TEARS