It is essential to understand that not all SLAP tears are created equal. Initial physical examination includes visual inspection for gross asymmetry and muscle atrophy. [2][9][6][12], Non-operative management focuses on the initial restriction of provoking maneuvers. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. In throwing athletes, a progressive throwing program that is directed toward the patients' specific sport and position can be initiated after 3 months.[2]. Neuman BJ, Boisvert CB, Reiter B, Lawson K, Ciccotti MG, Cohen SB. Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Tenodesis can be performed by subpectoral, all-arthroscopic, and mini-open techniques. In addition to axillary nerve function, motor function of the elbow, wrist, and hand should undergo an assessment to rule out the possibility of a brachial plexus injury associated with the dislocation. Special tests that are helpful in this regard include the Spurling maneuver, myelopathic testing, reflex testing, and a comprehensive neurovascular exam. For the physical examination the therapist uses the tests described in ‘Diagnostic Procedures’, but apart from that he can also test the glenohumeral and scapulothracic range of motion because there could occur a dyskinesis caused by the SLAP lesion. Moreover, patients will often present with an MRI final report stating a SLAP tear was present on imaging. The recess/sulcus can be present during fetal development as early as 22 weeks of pregnancy, persisting throughout childhood and into adulthood. Repetitive overhead motion may also lead to the attenuation of static stabilizers, resulting in altered biomechanics of the dynamic stabilizers. Type VI: an unstable flap tear of the labrum in conjunction with a biceps tendon separation. In this study (also studying over 100 shoulder cadaver specimens), the attachment sites clarified the findings from the previous study: The latter study is the contemporary consensus agreement regarding the LHBT attachment patterns. A sling with an abduction pillow is typically utilized with avoidance of external rotation and abduction. Chronic anterior and posterior instability patients may also exhibit corresponding posterior and anterior acromial prominences, respectively. There are several proposed mechanisms for the cause of SLAP tears. After probing to confirm the diagnosis of a SLAP tear, a shaver can be used to resect unstable flaps of tissue that are deemed irreparable. [36] http://creativecommons.org/licenses/by-nc-nd/4.0/. [6] The former implicates the late-cocking phase of throwing, while the latter would theoretically implicate more traction-based mechanisms. Kuhn JE, Lindholm SR, Huston LJ, Soslowsky LJ, Blasier RB. Essential to full recovery from a Type II SLAP ( S uperior L abral tear from A nterior to P osterior) Lesion is protection of the repaired labrum. A tear of the labrum below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. A positive test is a pain or a painful pop over the anterior shoulder near the bicipital groove region. [3][5], The long arm of the biceps inserts directly into the superior labrum, which also provides stabilisation to the superior part of the joint. Asymptomatic tears should be observed. Pandya NK, Colton A, Webner D, Sennett B, Huffman GR. Pathophysiology. The outcome of type II SLAP repair: a systematic review. [1], In various patient populations, internal impingement is also a culprit of SLAP tears. El labrum ayuda a mantener el hueso del brazo dentro de la cavidad del hombro. Avoid extremes of abduction and external rotation. The authors noted that in cases of a positive peel-back sign (i.e., not present in normal shoulders during an arthroscopic examination), the biceps anchor assumes a more vertical and posterior angle that is dynamically visible. Waterman BR, Arroyo W, Heida K, Burks R, Pallis M. SLAP Repairs With Combined Procedures Have Lower Failure Rate Than Isolated Repairs in a Military Population: Surgical Outcomes With Minimum 2-Year Follow-up. The following causes have been found: The two most common mechanisms are falling on an outstretched arm in which there is a superior compression, and a traction injury in the inferior direction.[6]. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. Erickson BJ, Jain A, Abrams GD, Nicholson GP, Cole BJ, Romeo AA, Verma NN. The incidence of SLAP tears is a controversial topic in the current literature. Distal pulses should be assessed at the wrist as well. [6][4]In addition, the rotator cuff muscles are essential to ensure dynamic shoulder stability as they prevent excessive translations of the humeral head at the level of the glenoid fossa.[7]. The Type II SLAP lesions have been further divided into three subtypes depending on whether the detachment of the labrum involves the anterior aspect of the labrum alone, the posterior aspect alone, or both aspects. Ultimately, nonoperative and operative management yields successful results for many patients; however, treatment success is highly dependent upon the patient's functional level and treatment goals. The patient is standing, and the arm of interest is positioned at 90 degrees of forward flexion, 10 degrees of adduction, and internally rotated so the thumb points toward the floor. [Updated 2022 Sep 4]. Also suprascapular neuropathy secondary to cyst compression in the spinoglenoid notch may occur in association with SLAP tears. [19][20][4] Subsequently, as the understanding of the injury continued to unfold, rates of repair have steadily declined. Tears of the glenoid labrum sensations of painful clicking and/or popping with shoulder movement, loss of glenohumeral internal rotation range of motion, loss of rotator cuff muscular strength and endurance, loss of scapular stabiliser muscle strength and endurance, inability to lie on the affected shoulder. Type VII: a superior labrum and biceps tendon separation that extends anteriorly, inferior to the middle glenohumeral ligament. The term SLAP stands for Superior Labrum Anterior and Posterior. [3]But the humeral head is larger than the fossa and so the socket covers only a quarter of the humeral head. [5][6] Specific populations, however, can present with increased rates of SLAP tears, with one study demonstrating upwards of an 83% prevalence in overhead athletes.[1]. In these scenarios, SLAP tears present with the insidious onset and progressive deep shoulder pain in young athletes with the arm in the abduction and external rotation position during the late-cocking phase of throwing. [11] There are studies who combined few of the tests but the data differ too much therefore it’s difficult to make a general conclusion. This rotator interval has a triangular shape in which the supraspinatus is superiorly located, the subscapularis inferiorly and the processus coracoideus medially. As knowledge has evolved through time, with improvements in magnetic resonance imaging (MRI) quality, SLAP tears subsequently became a more frequent diagnosis. In the age category 30 to 50, there are more chances of tears/defects in the superior and anterior-superior regions of the labrum (noted in cadavers). SLAP lesions are lesions of the superior labrum in which there are several types described. The shoulder joint is composed of the glenoid (the shallow shoulder "socket") and the head of the upper arm bone known as the humerus (the "ball"). The specific etiology underlying the various SLAP tear presentations is multifactorial and remains a topic of debate and controversy. It also becomes more brittle with age, and can fray and tear as part of the aging process. [39] A structured advancement of strengthening sports specific rehabilitation and dynamic exercises are continued for several months. Jobe FW, Giangarra CE, Kvitne RS, Glousman RE. They may complain of night pain, which is a common complaint with several shoulder pathologies. Initial evaluation of the shoulder typically starts with x-rays to rule out osseous pathology. NSAIDs and cryotherapy device/ice pack application can be beneficial for pain control. Oper Tech Sports Med, 2012;20 (1):46 – 56, MYERS J.B. et al., Sensorimotor deficits contributing to glenohumeral instability. In fact, superior outcomes have been reported in this particular subset of athletic patients following non-surgical management alone. Superior Scapes, Inc. is a locally owned and operated full-service landscape company serving the Central New York area since 1990. However, the achievement of adequate shoulder mobility is an important condition to begin resistance training. [9][11][13] It is important to keep in mind that while labral pathologies are frequently caused by overuse, the patient may also describe a single traumatic event. Trends in the early 2000s showed an increase in SLAP repairs. et al., Shoulder rotator strength and torque steadiness in athletes with anterior shoulder instability or SLAP lesion. Brockmeyer M, Tompkins M, Kohn DM, Lorbach O. A 2012 study evaluating trends in SLAP repair found SLAP tears were more common in men (greater than 3:1) compared to women. Initially rest post the acute (or acute-on-chronic) injury should be implemented. The investigation of choice is an MR arthrogram, which is variably reported as having accuracies of 75-90%, although distinguishing between subtypes can be difficult. A paralabral cyst found on MRI is a diagnostic clue for a SLAP tear. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. [12] These concepts are further realized by the fact that a formal diagnosis code was not available until 2001, and it took until 2003 to institute a separate Current Procedural Terminology (CPT) code: 29807. [18] However, in younger patients presenting with shoulder instability, the SLAP injury may be present and contributing to symptoms, especially in the setting of an acute anterior and/or posterior labral tear. Brockmeier SF, Voos JE, Williams RJ, Altchek DW, Cordasco FA, Allen AA., Hospital for Special Surgery Sports Medicine and Shoulder Service. Typically, an anti-inflammatory and/or corticosteroid injection are utilized as initial treatment as well. [19][21] The recent overlying trend appears to favor tenodesis rather than repair; however, the decision for the type of intervention remains patient-specific. Original Editor - Kristin Sartore, Venugopal Pawar, Top Contributors - Venugopal Pawar, Lucinda hampton, Fasuba Ayobami, Kim Jackson, Rachael Lowe, Claire Knott, Amrita Patro, Wanda van Niekerk, Vasileios Tyros, Admin and WikiSysop. There are numerous physical examination procedures described to detect the SLAP lesion: A combination of 2 sensitive tests and 1 specific test is more efficient to diagnose a SLAP lesion [reference needed]. Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction. Onyekwelu I, Khatib O, Zuckerman JD, Rokito AS, Kwon YW. What this means is that the labrum is torn at the superior (top) of the glenoid. The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs. Intervention and outcome: A conservative chiropractic treatment plan in addition to physical therapy was initiated. In the ensuing decades, other groups, including Morgan et al. Shin SJ, Lee J, Jeon YS, Ko YW, Kim RG. [22] Tenotomy can lead to a cosmetic deformity with retraction of the biceps muscle. [15][16], Nonoperative management has efficacy for many symptomatic SLAP tears and should be considered for initial treatment. Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. The location you tried did not return a result. It can be caused by a forceful overhead motion, or when you try to catch something heavy. [11], It is important to keep in mind that the scapula is an important factor during shoulder movements. [10], For the vast majority of SLAP injuries, the initial management is nonoperative. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Maffet MW, Gartsman GM, Moseley B. Consultations should include primary care sports medicine specialists experienced in managing SLAP tears nonoperatively. Read more, © Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. The physical requirements of military service may contribute to an increased. Superior labrum anterior to posterior (SLAP) tears are a subset of labral pathology in acute and chronic/degenerative settings. El labrum glenoideo, recordemos, es un anillo de fibrocartílago que aumenta el diámetro efectivo de la glenoides respecto a la cabeza humeral. Examiners should observe and compare bilateral shoulder girdles for any notable asymmetry, scapular posturing, muscle bulk comparison, or any atrophic changes. The skin should also be evaluated for prior surgical incisions or injuries attributed to an acute mechanism. Superior labrum-biceps tendon complex lesions of the shoulder. Access free multiple choice questions on this topic. Sports Phys. But if all three tests are positive this will result in a specificity of about 90%. and Maffet et al. Charles MD, Christian DR, Cole BJ. Outline the appropriate evaluation of superior labrum lesions (SLAP tears). This decreases the normal shoulder function. Mechanism of initial injury should be considered to avoid repeating the maneuvers and stressing the repair. The involved shoulder is positioned at neutral, the elbow is flexed to 90 degrees, the forearm is supinated, and the patient makes a fist. [2][28]This way, physical treatment can be started sooner. Sometimes morphological varieties can be confused with pathological aspects and therefore diagnosis should be established following careful analysis of the case history and a physical examination. Physical Examination Pearls [1][2] Snyder developed the initial 4-subtype classification of these lesions. [57] Professional baseball pitchers demonstrate relatively inferior outcomes regarding return to play and return to prior performance level. Trends in the diagnosis of SLAP lesions in the US military. Pertinent elements in history taking to best elucidate the nature of a potential SLAP tear (or other associated shoulder injuries) include:[33][34][35]. This activity will review the pathophysiology, classification, and treatment options for SLAP lesions and examine the role of physicians, physician assistants, nurses, physical therapy teams, and medical assistants in optimizing collaboration to ensure patients receive high-quality care, which will lead to enhanced outcomes. ( [15] Additionally, we now recognize that SLAP lesions commonly occur in asymptomatic overhead athletes. To reduce the risk of injury, especially in overhead athletes, there should be a focus on flexibility, periscapular, and shoulder girdle strengthening as well as proper mechanics. Popp D, Schöffl V. Superior labral anterior posterior lesions of the shoulder: Current diagnostic and therapeutic standards. Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. The patient stands with his or her hand of the involved arm placed on the ipsilateral hip with the thumb pointing posteriorly. Long-term results after SLAP repair: a 5-year follow-up study of 107 patients with comparison of patients aged over and under 40 years. SLAP tears involve the superior glenoid labrum, where the long head of biceps tendon inserts. Am J Sports Med., 2013;41:880–886, ALPERT J.M. The therapist can choose the 2 sensitive tests out of the following 3: For the specific test, the therapist may choose out of the 3 following: If one of the three tests is positive, this will result in a sensitivity of about 75%. As pain recedes and range of motion is returned, dynamic strengthening exercises and sport-specific protocols are initiated. Three distinct variations occur in over 10% of patients: In the acute setting, they are most frequently seen in falls onto an outstretched arm or in throwing sports athletes. Retrieved from, WILLIAM F.B., Correlation of the SLAP lesion with lesions of the medial sheath of the biceps tendon and intra-articular subscapularis tendon .Indian J Orthop. The aim of this paper is to provide a brief description of the different surgical techniques employed to address Type II SLAP lesions (arthroscopic repair, biceps tenodesis, and biceps tenotomy) and provide a review of available literature regarding outcomes and prognostic factors associated with each technique. The determination of appropriate anchor placement depends on the predominant region of instability regarding the superior labral-biceps tendon complex. Active and passive motion needs to be assessed and compared to the contralateral side. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Weber et al. Superior labrum lesions, or frequently referred to as superior labrum anterior to posterior (SLAP) tears, are a subset of injuries of the labrum in the shoulder that occur in acute and chronic/degenerative settings. Understanding the rigorous rehabilitation required from advanced procedures helps the patient understand what is expected on their road to recovery. OK to begin biceps resistance exercises beyond 6 to 8 weeks postoperative. [12], Similarly, a 2012 study reported the rising incidence of arthroscopic SLAP repair rates within New York State from 2002 to 2010, noting a 464% increase in the number of SLAP repairs. As mentioned, this concept can also be applied to the young, athletic population as well. Etiology The beam can otherwise be rotated while the patient is neutral in the coronal plane. [17], Beside biceps tears, other problems, such as bursitis and rotator cuff tears, are often identified, in combination with SLAP lesions,[18]According to Morgan CD et al., Rotator cuff tears were present in 31% of patients whit SLAP lesion and were found to be lesion-location specific.[19]. Type I concerns degenerative fraying with no detachment of the biceps insertion. reported surprising trends after mining the American Board of Orthopaedic Surgery (ABOS) Part II database. There is an increasing body of literature evidence now recognizing that appropriate patient selection is critical. SLAP Lesions: Trends in Treatment. [39][38] Thus, the inadvertent focus given to a potential SLAP lesion may be either overappreciated or misdirected. [23] Vangsness et al. Tears of the glenoid labrum fibrocartilage, also known as superior labral anterior to posterior (SLAP) lesions, are suspected clinically or noted on magnetic resonance (MRI) imaging. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon. Arthroscopy, 2010. As symptoms diminish, a structured rehabilitation protocol focusing on rotator cuff and pericapsular strengthening exercises are utilized. previously demonstrated that the tendon of the long head of the biceps contains a complex network of sensory and sympathetic nerve fibers. Yeh ML, Lintner D, Luo ZP. Superior Scapes | Liverpool NY They can extend into the tendon, involve the glenohumeral ligamentsor extend into other quadrants of the labrum. Park JH, Lee YS, Wang JH, Noh HK, Kim JG. [15], SLAP tear itself accounts for 80–90% of labral pathology in stable shoulder but it’s only found in 6% on arthroscopy. [18][23], Operative intervention in adults has been reported to be successful between 80 and 97% of patients in several populations. Superior labrum is more weakly attached to glenoid than inferior labrum. SLAP lesions of the shoulder. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Occur secondary to sudden jerking movements or after lifting heavy objects, Can occur after an unexpected pull on the arm. Orthop Traumatol Surg Res., 2015;101(1):19-24, STETSON, W. (2010). [28], Finally, the Buford complex is a congenitally absent anterosuperior labrum plus a thickened cord-like middle glenohumeral ligament. The Journal of Manual & Manipulative Therapy, 2001;9(2):71 – 83, WILK K.E. Phys. Sling immobilization until 4 weeks postoperative, Early shoulder pendulum exercises, periscapular muscle activation exercises. Re. Burkhart SS, Morgan CD, Kibler WB. The test registers positive only if it elicits pain deep inside the shoulder joint or at the shoulder's dorsal aspect along the joint line during the resisted movement. The palm is facing upward. Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms. INTRODUCTION SLAP tear refers to a specific injury of the superior portion of the glenoid labrum that extends from anterior to posterior in a curved fashion. [46]. Given the clinical complexity of SLAP injuries and concomitant shoulder pathologies, early consultation with an orthopedic surgeon is encouraged. Isolated tenotomy patients typically can resume activity within a week. Type III represents a bucket-handle tear of the labrum with an intact biceps tendon insertion to the bone. Unstable SLAP lesions are typically repaired with anchor fixation, and the extent of the injury typically determines the pattern of repair. StatPearls Publishing, Treasure Island (FL). Throwing athletes and weightlifters can be injured this way. [8], Throwers can have repetitive microtraumata. The findings can be rather subtle, especially in obese patients. SLAP tears involve the superior glenoid labrum, where the long head of bicepstendon inserts. O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. [39]. Following the observational component of the physical examination, the active and passive ROM are both documented; this may be limited in the setting of initial follow-up in the clinic after an acute instability event or the setting of any complex instability case, especially in the setting of glenoid bone loss. A typical symptom is intermittent pain that also occurs in overhead movements. [36], Mayo Shear Test (also known as the Modified O’Driscoll Test or the Modified Dynamic Labral Shear Test: II. A SLAP tear stands for Superior Labrum, Anterior to Posterior. A total of four types of superior labral lesions involving the biceps anchor have been identified. Variability in the anatomy of the biceps anchor and tendinous origin translates to varying levels of strain on the superior labrum. Healing time constraints are critical. The Neviaser portal is often utilized and established under direct visualization once confirming the appropriate trajectory are achieved. In 2005, an MRI analysis of professional handball players demonstrated abnormalities in 93% of shoulders, with only 37% being symptomatic.[48]. Taylor SA, Degen RM, White AE, McCarthy MM, Gulotta LV, O'Brien SJ, Werner BC. Mathew CJ, Lintner DM. Smith R, Lombardo DJ, Petersen-Fitts GR, Frank C, Tenbrunsel T, Curtis G, Whaley J, Sabesan VJ. Hippensteel KJ, Brophy R, Smith MV, Wright RW. Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears. Am. Summarize interprofessional team strategies for improving care coordination and communication to enhance outcomes for patients affected by superior labral anterior to posterior (SLAP) lesions. [23][26][27][28][29][30] Non-overhead athletes return to sport at a consistently higher rate, although some patients inevitably are unable to return to participation. Find top doctors who treat Labral tears near you in Liverpool, NY. It can also be caused by repetitive motions. [13][14], The glenoid labrum is often involved in shoulder pathology. In older patients and the setting of suspected concomitant shoulder pathologies (e.g., rotator cuff injuries or biceps tendon pathology), specialized testing for these pathologies also merits consideration. Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E. Biceps Tenotomy Versus Tenodesis. Superior migration of the humeral head can result from a rotator cuff that is not effectively performing its role as a humeral head depressor. Also, shoulder girdle proprioceptive training is beneficial to help prevent re-injury. [2][10]Postoperative rehabilitation is determined by the type of SLAP lesion, the chosen surgical procedure and other concomitant pathologies and procedures performed. At four weeks, progressive range of motion exercises are continued; however, active external rotation and abduction are still avoided. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the labrum above the middle of the glenoid that may also involve the biceps tendon. Dines JS, Elattrache NS. [2]Given that conservative management only seems to be successful in a few patients, mainly in type I SLAP lesions, it is only implemented in patients with this type of lesion or patients who do not wish to undergo surgery. American Journal of Sports Medicine, 2008;36:353-359, COOK C. et al., Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesion. Clinicians should focus on the potential relevance of the SLAP lesion as it attributes to the specific patient’s pain and dysfunction. The patient places their hand on the contralateral (normal) shoulder in a “self-hug” position. SLAP (superior labrum anterior and posterior) tears are injuries to the uppermost part of the labrum, where the biceps tendon attaches to the shoulder. A positive test is denoted by pain located at the joint line during the initial maneuver (thumb down/internal rotation) in conjunction with reported improvement or elimination of the pain during the subsequent maneuver (palm up/external rotation). Guanche CA, Jones DC. Alternatively, the biceps anchor may be sacrificed, and a biceps tenotomy or tenodesis performed. However, the ideal treatment of SLAP tears was never fully elucidated, and thus the increasing recognition of SLAP injuries brought about an increased incidence of SLAP repair rates across institutions. et al, The recognition and treatment of superior labral (SLAP) lesions in the overhead athlete. Regardless of the underlying etiology, patients presenting with symptomatic SLAP tears will commonly report the acute onset of deep shoulder pain accompanied by mechanical symptoms such as popping, locking, or catching with various shoulder movements. “Type III plus anterior shoulder instability.”, Type III tear pattern plus extension into the LHBT. 27, issue 4, p. 556-567, BOILEAU P. et al., Arthroscopic treatment of Isolated Type II SLAP lesions. The examiner then applies a downward resistive force just distal to the elbow while asking the patient to perform a throwing motion. Scapulothoracic dyskinesia may result from any degree of imbalance of the shoulder girdle muscles and static/dynamic glenohumeral joint stabilizers. Access free multiple choice questions on this topic. The odds ratio for revision surgery was 3.5 in the setting of LHBT tendinitis alone. What causes it? Insertion to the superior glenoid remains intact. Clinicians should inquire regarding certain history elements that may help differentiate SLAP tears from other shoulder injuries. A multifaceted approach to treatment is required for successful outcomes. Furthermore, biceps tenodesis may provide a viable alternative for the salvage of a failed SLAP repair. An anatomical study of 100 shoulders. A superior labrum anterior and posterior (SLAP) tear involves a tear in the 10 o'clock to 2 o'clock positions on the Orthop., 2014; 5(3): 344-350, PAINE R. et al., The role of the scapula. Some tests isolate the tension placed on the superior labrum by the biceps via provocative maneuvers in active and passive forms. The patient is eventually advanced to a strengthening phase, which includes trunk, core, rotator cuff, and scapular musculature. Degenerative SLAP tears often affect overhead laborers with increasing degrees of association in patients over 40 years old[8], It is important to appreciate the limitations in our ability to accurately report the definitive epidemiological trends as the contemporary recognition and diagnosis of SLAP injuries remains debated. If the non-operative therapy fails and symptoms persist that prevent sports activities or activities of daily living, then this would indicate the need for operative treatment. Treatment failure and complications are dependent upon intervention, patient adherence to rehabilitation protocols, and patient-specific factors. Type II is the most common type and represents a detachment of the superior labrum and biceps from the glenoid rim. That is usually the journal article where the information was first stated. The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. SLAP-lesion-specific physical examination tests have been developed to improve clinical acumen. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. [16]SLAP lesion is mostly combined with a lesion of the proximal head of the biceps because it attaches on the superior part of the labrum glenoidalis. While elite athletes and young patients typically undergo repair, these techniques provide satisfactory results for a wide variety of patients. The skin should be observed for the presence of any previous surgical incisions, lacerations, scars, erythema, or induration. [28] It is generally recognized that the majority of patients with symptomatic SLAP lesions will fail conservative management, particularly throwers. [53][54][55] A number of authors report good results in athletes, including those with sport-specific overhead demand requirements. The upper, or superior, part of your labrum attaches to your biceps tendon. A stabilizing role of the glenoid labrum: the suction cup effect J Shoulder Elbow Surg. When is surgery recommended? Additional subtypes for type II tears, as well as additional tear patterns, were described in subsequent years. An interprofessional team approach involving clinicians (including PAs and NPs), therapists, and orthopedically-trained nurses will provide the best results. 1173185. Unlike Bankart lesionsand ALPSA lesions, they are uncommonly (20%) associated with shoulder instability 5. [30][31], Boesmueller recently histologically characterized the most proximal extent of the LHBT, specifically the neurofilament distribution, as the tendon transitions into the superior labral complex. Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Gentle passive and limited active range of motion exercises is recommended for the first four weeks. Common SLAP-provoking sports include but are not limited to: Overhead sports (volleyball, baseball pitchers, javelin, swimming), History or current manual/physical laborer occupations, Atraumatic, insidious onset of anterior shoulder pain, Symptom exacerbation with overhead activities, Pain radiating down the anterior arm from the shoulder, Clicking or audible popping reported in the setting of proximal biceps instability. The examiner then applies terminal external rotation until resistance is appreciated. These are identified by smooth rather than rough edges, specific anatomic locations, and orientation medially rather than into the lateral substance of the labrum. There is a wide variety of pathology, and patient-specific characteristics and goals heavily influence treatment options. A physical exam led to differential diagnoses of a Superior Labrum Anterior to Posterior (SLAP) lesion, Bankart lesion, and bicipital tendinopathy. Isolated type II superior labral anterior posterior lesions: age-related outcome of arthroscopic fixation. Gentle ROM activities are recommended. Additionally, adolescents also demonstrated successful outcomes with operative repair in regards to pain and function; however, there remain similar considerations regarding return to sport. They also noticed that the type II SLAP lesions in patients under 40 were associated with a Bankart lesion, other than a type II SLAP lesion in patients under 40 years old, whose SLAP lesion were associated with a tear of the supraspinatus tendon and osteoarthritis of the humeral head.[6]. Finally, SLAP tears can occur in a degenerative setting for the aging population. Typically, an MR arthrogram (MRA) is performed to evaluate the shoulder labrum. Determining the onset of symptoms and mechanism (trauma, dislocation, or exacerbating maneuvers with overhead activity) can clue an examiner into labral pathology. Summarize interprofessional team strategies for improving care coordination and communication to enhance outcomes for patients affected by superior labral anterior to posterior (SLAP) lesions.
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