SLAP Tear of the Labrum - Surgery or Physical Therapy?

About three months ago I suffered what has now been diagnosed as a SLAP Tear of my left labrum (specifically a Type II tear).  I've gone through an MRI and a discussion with my doctor, but interested in hearing what experiences other climbers have had.  Right now I have two options, 1) surgery and 2) physical therapy.  Currently I am taking option 2 with the ability to decide on surgery later down the line.  After 3 months of recovery I am climbing a few letter grades below my pre-injury level.  Strength is down, but I have most of my mobility recovered.  Some daily chores and movements are uncomfortable, but overall I have all my occupational ability from before the injury.

What I'd like to know is if you've chosen to have surgery or abstain from it and what type of experience you've had since then.  Also, if you've had surgery or PT in the San Francisco area and have someone you'd suggest I'll happily take suggestions.  

Finally, the prognosis for recovery post-surgery is good (my rotator cuff and all surrounding muscles/tendons are in good shape), but it seems like recovery will take about 4 months with no climbing and heavy focus on PT.  Is that a typical amount of time for recovery?  Is it possible to have a more aggressive recovery schedule?

Thanks for any insight...and yes, I'm gunna die!  

I incurred a SLAP tear in my left shoulder in 2009 doing a very shouldery move climbing. I opted to go with PT and strengthening and so far it's still holding up well (I'm climbing as hard or harder as I did before the injury.) It was quite weak for a couple of months post-injury and occasionally it annoys me and feels like something "is out of place" in there but relaxing and/or laying on the bed face down with my arm hanging off the edge for a bit gets me set again. In short, I wouldn't jump to the surgical option and would try PT/strength work for a bit. 

Re: surgical recovery time, 4 months sounds quite fast for a SLAP tear surgery from what I've read but I have no direct experience with it. I tend to think 6 to 9 months, maybe a year, for recovery for it. 

Jason Halladay wrote:

I incurred a SLAP tear in my left shoulder in 2009 doing a very shouldery move climbing. I opted to go with PT and strengthening and so far it's still holding up well (I'm climbing as hard or harder as I did before the injury.) It was quite weak for a couple of months post-injury and occasionally it annoys me and feels like something "is out of place" in there but relaxing and/or laying on the bed face down with my arm hanging off the edge for a bit gets me set again. In short, I wouldn't jump to the surgical option and would try PT/strength work for a bit. 

Re: surgical recovery time, 4 months sounds quite fast for a SLAP tear surgery from what I've read but I have no direct experience with it. I tend to think 6 to 9 months, maybe a year, for recovery for it. 

Thanks Jason.  That is more or less where I am right now.  Glad to hear that forgoing surgery is a viable option, at least for now.

I'll look around for recovery times, but have no reason to distrust the number I got from my doctor.  We started talking climbing and it sounds like he has a good amount of experience performing this procedure on athletes and active people in general.  

I suffered a tear of the right shoulder labrum playing football in high school, I underwent intensive PT for two months and had good strength and capability but less range of stable motion and my shoulder was unstable under load and had a tenedency to disloacate easily plus it was sore after moderate movement . I chose to undergo surgery and after 3 months had most of my range of motion back and my strength was better than pre injury levels with no pain and most of my full range of motion. It all really depends on your personal feelings of how good your shoulder is with only PT.

Also try exercises that strengthen the small stablizer muscles of the shoulder, they help awesomely.

Suffered a SLAP tear during high school baseball. I went down the PT path for about 8 months and continued to pitch until it became so excruciatingly painful that I decided to go down the path of surgery. What I can comment from this expierence only relates to overhand throwing because I was not climbing at that point in my life. Although, in my opinion, pitching is more strenuous on the labrum and shoulder joint than climbing.

The recovery was long and painful. It took me about 4 months post op to start throwing a baseball again (light tosses) and 8 months for full speed throwing. After 1 year I would say I had about 85% of my strength back but that was dedication to some pretty stringent training. Took about 18 months to feel like "nothing ever happened"

The biggest downside of getting surgery (in my opinion) is that you seriously baby your arm. You are afraid to use it, it takes a little while to get yourself out of that mindset. For me it took18 months because every time I threw a baseball I felt like I was going to blow out my arm again since that was how I hurt it.

Looking back, surgery was right for me. It allowed me to get stronger after the fact and I have no pain at all in that shoulder anymore. I am well beyond the strength I had pre op and if it wasn't for the scars I would honestly forget I had surgery. But is surgery right for you is honestly up to you and your end goals in climbing. If you're just trying to have fun with climbing and your shoulder doesn't hurt all that much aside from pushing your grade. I'd say maybe decide against surgery. That's a decision you'll have to make after a few months of PT. But if you're dying to train and get your grade up and your shoulder is killing you, surgery may be the only path.

Hope this helps a little!

PT should be the first-line response pretty much always... even if you end up doing surgery later, the stronger/more balanced your shoulder is before surgery, the better the recovery would be.

SLAP tear is one of those things that could go either way. Plenty of people walk around with a SLAP tear, and don't even know it. Plenty of climbers have it, and see only occasional twinge, or maybe need to baby the shoulder a bit, and stay on PT regimen long-term.

I did PT for about 6 months after I was informally diagnosed with SLAP tear (didn't get a formal diagnosis until 3 months after the injury, because that is the reality of MRI, etc). I was able to climb with SLAP tear, and even climb pretty well, as long as I avoided certain shouldery moves. But decided that the constant recurring pain was not worth it, and opted for surgery.

It was a good decision for me. Going in for surgery,  I was told no climbing for about 5-6 months post surgery, but at 3.5 months checkup the Dr said I could try climbing ,as long as I started out slowly and carefully. The recovery curve was pretty steep, once I started climbing again, and I was pretty much back to normal/recovered to pre-surgery level of climbing at 7 months. I was doing intensive PT for that entire time.

2023 bump... I'm in a similar boat. Type 2 SLAP tear confirmed by MRI. I'm leaning towards surgery as I am in my late 30s and realize that if I ever want to get this fixed, the earlier the better while my body is still able to heal itself well. Does anyone have any recent experiences? My ortho surgeon is a climber and has performed this on other climbers here in Seattle. He says there's about an 80% success rate at getting people to their previous level, and gives a 6-month out-of-action recovery time, at which point he says I could begin to climb a little bit. Overall he sounded pretty conservative and not trying to sell me on getting cut open right away. I can still climb pretty well but my shoulder is always mildly aggravated the next day, even just by sleeping on that side. This is with me trying to mind it while climbing, avoiding big shouldery moves and cutting feet. I stopped moonboarding completely. I figure if I really want to push my climbing that I should get it fixed, but I'm curious to hear if there have been other recent experiences on this here.

BTW I think mine was caused by overzealous belaying, specifically feeding out slack in a huge motion with a grigri, but I can't be sure.

I put off the surgery for a year and it only got worse. Ended up popping in and out of the socket while driving. Recovery in a climbing sense from the surgery took about a year. Go to a surgeon who does a lot of them.  Edited after seeing your comment regarding level to say I climb harder than before. This is not to say I am symptom free, but it's better than pre-surgery for sure.

James C wrote:

2023 bump... I'm in a similar boat. Type 2 SLAP tear confirmed by MRI. I'm leaning towards surgery as I am in my late 30s and realize that if I ever want to get this fixed, the earlier the better while my body is still able to heal itself well. Does anyone have any recent experiences? My ortho surgeon is a climber and has performed this on other climbers here in Seattle. He says there's about an 80% success rate at getting people to their previous level, and gives a 6-month out-of-action recovery time, at which point he says I could begin to climb a little bit. Overall he sounded pretty conservative and not trying to sell me on getting cut open right away. I can still climb pretty well but my shoulder is always mildly aggravated the next day, even just by sleeping on that side. This is with me trying to mind it while climbing, avoiding big shouldery moves and cutting feet. I stopped moonboarding completely. I figure if I really want to push my climbing that I should get it fixed, but I'm curious to hear if there have been other recent experiences on this here.

BTW I think mine was caused by overzealous belaying, specifically feeding out slack in a huge motion with a grigri, but I can't be sure.

My understanding is that "slap tear" is a broad diagnosis.  Different locations and severities can big impact.

That said I had a slap tear from BJJ that started with just a shoulder after training that I mostly ignored until one day I couldn't lift my arm enough to take off my shirt.  Luckily my shoulder responded to PT but it took maybe a year to be 100% but I was in my late 40s at the time.  Even now if I slack off on my shoulder strength work it will get each again.

I was back to climbing before belaying!  I know exactly what you mean about feeding rope with L arm from grigri quickly being hard on the shoulder.  I wound up switching to ATC for a few months while my shoulder healed up.

I initially dislocated my shoulder playing basketball. Then had a subsequent dislocation snowboarding and finally climbing. After trying to manage it with PT for 15 years I opted for a SLAP repair. I probably should have got it done after the second dislocation. Very happy I got the surgery. I think I was about 6 months till I could really push it again. Probably 2 or more years till it felt normal again. However, 15 years of guarding builds some very ingrained patterns so I'd imagine your recovery would likely be more expedited. My decision to opt for surgery was based on a high likely hood of more dislocations.

Provided you do not have instability in the joint, I would go the PT route.

I have labral tears in both shoulders which are completely asymptomatic. I am religious with my PT, climb a ton, and have no limitations. 

It will take time for it to settle down (could be months), but that will be far better than recovery from surgery. Surgical outcomes are not a guarantee. Regaining full ROM can be difficult with labral repairs.

A labral repair takes 3 months to regain general function, 6 months until you can start very light climbing, 9 months until you can climb close to where you were pre injury, and a full year to regain full strength.

Nice to hear the different perspectives. I tried PT for 2 months, and got a little better but it still got aggravated after/during sport. It definitely has settled down though. Injury happened in March. Has anyone had experiences ice climbing or drytooling with labral tears? Just hanging on my tools, if I don't have my shoulder engaged just right, I feel it flare up. Too apprehensive to try a single arm hang. My surgeon was telling me how pretty much overhead reachy moves, and things like throwing a ball will be limited, and that sounds much in line with ice climbing movement.

I had a slap tear that created swelling that dried up and created a cyst. This was compressing a nerve that made me lose function in my rotator cuff. Surgery was my only option to regain the use of my supraspinatus. I did pt for around 6 weeks before it got way worse. My dr also reccomended a biceps tenodesis as he said with my age and activity level, I'd just tear it again if he left the bicep attached.

I'm at 8 months out, and and am back to about 80-85% of my previous level of fitness and have already sent 5.12 again. I would 100% do the surgery again, but every case is different. I went to dr Coons in Tacoma, and would fully recommend him. He did an amazing job and was super clear about my options etc. 

I'm planning on writing a full report about my process shortly for those staring at the same decision I had.

Good luck

As I climb more with my tear, I'm leaning away from surgery. I talked to my surgeon and he recommended pushing it a bit to test it. Tried moonboarding for the first time in many months and it wasn't bad. From the sounds of it, it seems like most have resorted to surgery only when they lost a huge amount of their shoulder function or multiple dislocations (I've never had a dislocation). Mine still is uncomfortable when I sleep on it, but day to day it's fine with some tweakiness. So onward to testing, next week is drytooling and pullups.