Advancements in shoulder arthroscopy have led to a better understanding of the anatomy and disorders of the superior labrum biceps tendon anchor complex and the role that lesions of the superior labrum anterior and posterior lesions play in pain and instability of the shoulder. Various injury mechanisms have been suggested and studied and it is likely that different mechanisms produce different types and areas of damage to the superior labrum. Classification systems have been proposed to describe the specific pathoanatomy of lesions of the superior labrum anterior and posterior lesions and to guide treatment. Presenting symptoms often are nonspecific and physical examination maneuvers have varying degrees of sensitivity and specificity making diagnosis challenging. Diagnostic ability is enhanced by the ultimate diagnostic test, arthroscopy. A clear appreciation for the various lesions and the potential resulting joint dysfunction is necessary to determine the appropriate treatment of this complex region of the shoulder. The current authors review the anatomy, classification, presentation, evaluation and treatment results of superior labrum anterior and posterior lesions, and includes novel evaluation methods and treatment guidelines useful in treating these lesions.