An Update on Diagnosing SLAP tears


Lenny Macrina

Physical Therapist United States

Diagnosing a SLAP tear is not easy

We hear a lot about trying to diagnose shoulder pain and to be as specific as possible. It’s often difficult to differentiate SLAP (superior labrum anterior to posterior) tears from other soft tissue injuries of the shoulder.

For a review of the different types of SLAP tears, check out this old blog post that classifies the 10 different types of tears.



This paper in IJSPT by Clark et al 2019 attempts to help out the process and recommend a few special tests that MAY aid in diagnosing a SLAP tear.

What do they Recommend to diagnose a slap tear?

They recommend that a combination of at least 3 positive SLAP lesion tests may be clinically useful in diagnosing a shoulder SLAP lesion with greater diagnostic accuracy.

Combo of Tests

The combination of the Biceps Load I/II and O’Brien’s showed the highest sensitivity and specificity.

I have found similar results with this set of special tests so maybe this paper just hits my biases correctly.

In this video at my YouTube channel, I wanted to let you hear my thoughts and small tweaks to the evaluation process.

It’s not easy to diagnose a SLAP tear.

Differential Diagnosis is Critical

Furthermore, does it really matter and will it change the treatment plan much at all? I think it may a little but overall it will remain a pretty similar treatment approach to other similar pathologies like:

    • rotator cuff tendonopathy
    • Biceps strain
    • Latissimus strain
    • Subscapularis strain
    • internal impingement
    • pectoralis major strain

I think one also needs to consider the cervical spine and to make sure the pain is not referred from the neck.

Otherwise, a well thought out program should be implemented that addresses the strain on the shoulder and any strength issues.

Will this Change your Practice?

How ever you look at it, I wanted to use this paper to let you know that there MAY be a cluster of tests that better diagnose a suspected SLAP tear in your next patient’s shoulder.

Check out the paper and comment so we can talk it through. Are these tests similar to what you use in your clinical practice? Will this paper change what you do in your clinical practice?

This was originally posted on Lenny Macrina’s website. You can click here to read more blogs from him.

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About the Author


Lenny Macrina

Physical Therapist United States

Lenny Macrina has been a practicing physical therapist since 2003 and currently serves as the Director of Physical Therapy at Champion Physical Therapy and Performance in Waltham, MA. His interests include research and rehabilitation of the shoulder, elbow and knee joints. He has successfully treated many orthopaedic and sports medicine related injuries that are both post-operative and non-operative in nature, in recreational athletes to the high-level professional athletes. Lenny is a board certified sports physical therapist by the APTA and a certified strength and conditioning specialist by the National Strength and Conditioning Association. In 2010, he was nominated by his peers to be included in the prestigious American Sports Medicine Fellowship Society which includes top fellowship-trained orthopaedic surgeons and physical therapists. Along with maintaining a full clinic schedule, he has co-authored various current concept papers, book chapters, research papers and a home study course for the APTA’s Orthopaedic section. He is a peer reviewer for the esteemed JOSPT and has reviewed rehabilitation textbooks and research papers for that journal. Through this research, he has been involved in numerous published articles in journals including: AJSM, JOSPT, Journal of Sports Health, Journal of Athletic Training, CORR, Operative Techniques in Sports Medicine, and many others. He has presented at various national conferences including APTA’s Combines Sections Meeting, ASMI’s “Injuries in Baseball Course”. Lenny received his Bachelor’s degree in Biotechnology from Worcester Polytechnic Institute and his Master’s degree in physical therapy from Boston University.

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