Our daughter is involved in volleyball at the collegiate level. Last week, she fell on her outstretched arm. The team physician thinks she has a SLAP tear that may require surgery. She’s in a city and state far from us. We can’t be there to walk through the process with her. How is this decision about surgery made?

SLAP stands for superior labrum, anterior and posterior. It refers to a torn rim of fibrous cartilage (the labrum) that edges the shoulder socket. The tear is at the top of the socket (that’s what superior means) and goes from the front (anterior) to the back (posterior) of the socket.

There are different types of SLAP injuries labeled Type I, Type II, Types III, and Type IV. The exact type depends on whether the labrum is frayed along the edges, partially torn, or completely pulled away from the bone.

Sometimes, the biceps tendon, which attaches along the upper front area of the socket is also pulled away. Labral tears may occur with or without biceps tendon disruption, which forms a separate classification or type of SLAP lesion. Two additional types (V and VI) have been named to include combined or complex SLAP lesions that aren’t fully described using I through IV.

Although the surgeon performs an examination of the shoulder and conducts numerous clinical tests, the exact lesion can’t be determined without imaging studies and arthroscopic exam. There are numerous tests designed to identify a SLAP lesion. MRIs are still considered the gold standard in diagnostic imaging for SLAP lesions. MRI results are important before heading into the operating room. They show the full extent of the damage, which may not be as easily seen during the procedure.

Most SLAP lesions do require surgery. But for a subgroup of patients with Type I lesions, conservative (nonoperative) care may be successful. This includes change in activity (no more throwing for a while), antiinflammatory drugs, and physical therapy. The therapist guides the patient through a process of reducing pain and restoring motion, strength, and normal movement patterns.

Anyone who has not obtained the desired results with conservative care is probably a good candidate for surgery. Patients with a SLAP lesion and a major tear of the rotator cuff (tendons around the shoulder) is also likely to need surgery. Anyone with a large labral tear who has altered biomechanics (movement of the shoulder complex is no longer normal) will benefit from repair rather than the nonoperative approach.