– Superior labral anterior-posterior (SLAP) tears are common shoulder injuries in overhead athletes like baseball players. Controversy exists regarding optimal diagnosis and management.

– Clinical tests like O’Brien’s sign have variable accuracy. MR arthrography better detects labral tears than standard MRI but accuracy remains imperfect.
– Many asymptomatic overhead athletes have MRI-detected labral abnormalities, so clinical correlation is critical.

– Multiple comparative studies show non-operative treatment focused on posterior capsule stretching and scapular mechanics has higher return to sport rates than surgery for most overhead athletes.

– A systematic review found wide ranging return to sport rates of 22-71% after SLAP repair surgery in overhead athletes.
– Debridement of unstable flaps may improve outcomes compared to repair. Anterior anchor placement risks external rotation loss.
– Outcomes are generally better in younger patients. Tenodesis or tenotomy is preferred for failed repairs in older patients.

– Moderate quality evidence, including cohort studies, supports initial non-operative treatment for SLAP tears in overhead athletes.
– Surgical repair may be considered after failed conservative treatment but outcomes are unpredictable. Further RCTs comparing treatments would strengthen the evidence base.

– Non-operative rehabilitation focused on posterior capsule and scapular deficits should be first-line for SLAP tears in overhead athletes.
– If surgery is pursued, treatment must be individualized based on patient factors. Further research is needed to optimize management.

In summary, while high level evidence is limited, recent studies suggest non-operative rehabilitation targeting modifiable impairments yields better outcomes than early surgical repair for SLAP tears in most overhead athletes. Individualized treatment is imperative.