If you have a SLAP tear, what is the appropriate treatment?

SLAP tears, particularly Type 2--the most common, are typically repaired arthroscopically. See the video on the Shoulder section of this website. However, persistent pain and stiffness have led many shoulder experts to revisit the rationale for repair and to explore alternatives such as tenotomy and tenodesis. These options arguably call into question the role of the long head of the biceps in providing stability. Thus, if a SLAP tear causes pain, is repair th best option? I refer you to my post today on the Forums section of this website for more detailed information---but for the most part, Iam reluctant to fix SLAP lesions in patients in whom a traumatic etiology is absent, and in patients who are older than 40 years.
 
Why?---because in the last year I have had to perform revision surgery on 8 or so patients because of persistent pain. Following release/tenodesis, they have all gotten better. It's worth noting that John Elway (the well known Denver Bronco quarterback) actually underwent a simple biceps release (tenotomy), which allowed him to play another season before he retired. Though his biceps pathology was not a SLAP tear, but degeneration---his favorable outcome (even as a "throwing athlete") is noteworthy.

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