SLAP Tear diagnosis - what next?

[Chabach]

Coach Rip,
I've been doing my NLP for about 10 months now at SS Idaho, but have been held back by shoulder issues. I finally got an MRI and was diagnosed with a SLAP tear and some osteoarthritis. I'll add the details below in the hopes that you can answer a couple of questions. Any advice you can offer would be greatly appreciated, with the understanding that you're not a doctor. As this is my first post, let me also add a thank you for putting Starting Strength together in the first place, it's made a huge difference in my life and my partner's life (she lifts too!) already.

1. Is surgery optional, mandatory, worthless?
2. Are there any alternatives, apart from just lifting through it?
3. I've been strict pressing, squatting with the safety bar, and haven't been benching at all - even close grip, pinned press seemed to aggravate the shoulder. Should I stick with this, are there any other modifications I should make, should I just accept the pain and lift through it as best I can?
4. Are there any other exercises I should add as part of a rehab program?

My details: I'm 48, male, 5'11", 240 lbs, been training 10 months, on T, and my PRs: 340 squat with the safety bar (I've always had trouble with shoulder pain trying to get under the low bar/high bar), 360 deadlift, 155 normal press/135 strict press, 200 bench before the shoulder made me quit.

The MRI details:
Impression
1. SLAP tear from the 2:00 to 9:00 position (3:00 anterior).
2. Acromioclavicular joint osteoarthritis with prominent periarticular edema.
3. Tendinopathy of supraspinatus and infraspinatus.
Narrative
HISTORY: Left shoulder pain, unspecified chronicity.
COMPARISON: August 24, 2022
TECHNIQUE: Following the uneventful administration of intra-articular dilute gadolinium contrast, multiplanar MR images were obtained of the left shoulder.
FINDINGS:
Glenoid labrum: Superior labral tear extends both anteriorly and posteriorly from the 2:00 to the 9:00 position (3:00 anterior).
Rotator cuff: There is tendinopathy of supraspinatus and infraspinatus. Subscapularis and teres minor are intact.
Glenohumeral ligaments: Middle, and anterior and posterior bands of the inferior glenohumeral ligaments are normal.
Glenohumeral articular cartilage: Normal.
Long head biceps tendon: Normal.
Coracoacromial arch: Acromioclavicular joint is mildly degenerative. Acromion is type- II. There is no anterior or lateral acromial downsloping or spur.
Marrow: Edema about the acromioclavicular joint
Miscellaneous: There is no significant subacromial/subdeltoid bursal fluid.

[Mark Rippetoe]

What has the surgeon suggested?

[Chabach]

What has the surgeon suggested?

I just got back from seeing him. The surgeon suggests a bicep tenodesis and would 'clean up' some of the shoulder arthritis at the same time. He didn't push me to get the surgery immediately if I am able to manage symptoms and told me I should continue PT and get a steroid shot if the pain gets to be too much, which right now it isn't.
He also said at the gym I should try to keep my hands in my field of vision, rather than pressing overhead, and to consider dumbbells for the press and bench press. I refrained from telling him that he was going against the principles of Starting Strength.

So, is surgery really my only option? What modifications to the lifts should I consider in the gym? With PT and careful attention to form do I have any hope of going back to the standard lifts, or close to them?

[Mark Rippetoe]

He also said at the gym I should try to keep my hands in my field of vision, rather than pressing overhead, and to consider dumbbells for the press and bench press. I refrained from telling him that he was going against the principles of Starting Strength.

The "Principles of Starting Strength" involve answering why. I'll bet he didn't do that.

So, is surgery really my only option? What modifications to the lifts should I consider in the gym? With PT and careful attention to form do I have any hope of going back to the standard lifts, or close to them?

It's eventually going to have to be fixed. The younger you are when you do it, the better your outcome will be. But go into the surgery as strong as you can.

[Griffin727]

Go ahead get it done, that biceps is probably pulling on the labrum. I'm 26 and have had both my shoulders done. My numbers are back to normal and getting better. 370 bench, 230 press, 650 deadlift, 605 squat. Just listen to your surgon. The first year of rehab going to suck.