Am J Sports Med., 2010;38:2299–2303, EDWARDS S.L. The possibility of generalized hyperlaxity of tissues in all patients with instability should also be considered, and a Beighton score can easily be obtained. Less common than SLAP Lesions. Any evidence of significant muscular weakness may hint at an underlying associated neurologic deficit. , which are the serratus anterior, rhomboid major and minor, levator scapulae and trapezius. 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. Classically advocated by Snyder as his original case series from 1990 reported about half of the patient presentations were status post a fall onto an outstretched arm with the arm in varying degrees of shoulder abduction. As a surgical treatment for SLAP lesions, SLAP repair has been traditionally performed. The recess/sulcus can be present during fetal development as early as 22 weeks of pregnancy, persisting throughout childhood and into adulthood. It is associated with pain and instability and an inability of the patient to perform overhead movements. 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. Aflatooni JO, Meeks BD, Froehle AW, Bonner KF. ), which permits others to distribute the work, provided that the article is not altered or used commercially. It also becomes more brittle with age, and can fray and tear as part of the aging process. Shon MS, Jung SW, Kim JW, Yoo JC. Burkhart SS, Morgan CD. SLAP tears are typically defined as superior labrum fraying/tearing from the glenoid. Find top doctors who treat Labral tears near you in Liverpool, NY. This can lead to instability and, ultimately, impingement of the superior labrum with degenerative tearing. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. At month 4 to 6, dependent on the type of sport practiced, patients should be able to start sport-specific training and gradually return to their former level of activity.[2]. Jost B, Zumstein M, Pfirrmann CW, Zanetti M, Gerber C. MRI findings in throwing shoulders: abnormalities in professional handball players. Western Ontario Rotator Cuff (WORC) Index, https://radiopaedia.org/articles/superior-labral-anterior-posterior-tear, http://www.sportsmedicinedr.com/?page_id=715, https://www.ncbi.nlm.nih.gov/books/NBK538284/, https://www.physio-pedia.com/index.php?title=SLAP_Lesion&oldid=315450. Additional subtypes for type II tears, as well as additional tear patterns, were described in subsequent years. At the moment of the impact the glenohumeral contact point is shifted posterosuperiorly and increased shear forces are placed on the posterior-superior labrum, which results in a peel-back effect and eventually in a SLAP lesion.[6]. The variation in SLAP tear reporting may be attributed to some SLAP tears being considered an incidental finding on advanced imaging or at the time of arthroscopy. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears. [2]In the first step of conservative management, patients should abstain from aggravating activities in order to provide relief to the pain and inflammation. The acronym "SLAP" stands for Superior Labrum Anterior Posterior, and is used to describe a tear or detachment of the shoulder's superior glenoid labrum; generally originating at the anchor site for the long head of the biceps tendon and extending into anterior or posterior portions of the labrum. Demographic trends in arthroscopic SLAP repair in the United States. Etiology The beam can otherwise be rotated while the patient is neutral in the coronal plane. Several authors recommend against repair in these populations.[23][31]. The labrum is a cup-shaped rim of cartilage that lines and reinforces the ball-and-socket joint of the shoulder. Active strengthening of the biceps is still avoided. Rossy W, Sanchez G, Sanchez A, Provencher MT. Mathew CJ, Lintner DM. Sixteen commonly used shoulder rehabilitation exercises can be chosen on the basis of several EMG studies and clinical recommendations regarding the rehabilitation of patients with SLAP lesions. et al., Schoulder injuries in the overhead athlete. In these situations, evaluating the patient’s history of repetitive overhead activity or general functional history will help isolate suspicion towards the superior labrum. Type I tears are usually asymptomatic and do not require treatment, Type II tears require surgical reattachment, Type III tears usually require resection of the bucket handle tear, serratus punch (protraction with the elbow extended), forward flexion in external rotation and forearm supination, full can (elevation in the scapular plane in external rotation, forearm supination, elbow flexion in forearm supination, uppercut (combined forward flexion of the shoulder and flexion and supination of the elbow). Provocative Examination Testing/Maneuver: Over the last two decades, our knowledge and appreciation of SLAP tear recognition, diagnosis, treatment, and potential surgical management has evolved dramatically. Further, the age of patients operated on for SLAP tears was decreasing, and the majority of SLAP repairs still being performed by the latter half of the study were limited to mostly Type II SLAP tears. It contains the coracohumeral and the superior glenohumeral ligament, the biceps tendon and the anterior joint capsule. A positive test includes pain or a painful click on the anterior or posterior joint line. Scapulothoracic dyskinesia may result from any degree of imbalance of the shoulder girdle muscles and static/dynamic glenohumeral joint stabilizers. Type III represents a bucket-handle tear of the labrum with an intact biceps tendon insertion to the bone. Varacallo M, Tapscott DC, Mair SD. It deepens the cavity by approximately 50%. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Poor outcomes after SLAP repair: descriptive analysis and prognosis. Clavert P, Bonnomet F, Kempf JF, Boutemy P, Braun M, Kahn JL. Am J Sports Med., 2010;38:1456–1461, SACCOL M.F. The examiner then applies a downward resistive force just distal to the elbow while asking the patient to perform a throwing motion. Demographic trends in arthroscopic SLAP repair in the United States. Superior labrum anterior to posterior lesions and the superior labrum. In the chronic setting, degenerative changes within the shoulder may be present, and while testing of the superior labrum may be positive, it may not be the main cause of their symptoms. Special tests that are helpful in this regard include the Spurling maneuver, myelopathic testing, reflex testing, and a comprehensive neurovascular exam. ), which permits others to distribute the work, provided that the article is not altered or used commercially. Isolated tenotomy patients typically can resume activity within a week. Am J Sports Med., 2012;40(9):2105-2112, COOLS A .M. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) [1][2] Snyder developed the initial 4-subtype classification of these lesions. Weber SC, Martin DF, Seiler JG, Harrast JJ. [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. World J. Also, posterior shoulder joint capsular contractures should be addressed with various stretching and strengthening programs. [9], Postoperative rehabilitation for tenotomy and tenodesis of the biceps is typically included within the above protocols. Part II candidates. El labrum ayuda a mantener el hueso del brazo dentro de la cavidad del hombro. 2022 Dec . From the average age of 35, the superior labrum is less firmly attached to the glenoid than in people under the age of 30. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. If necessary, NSAID’s and intra-articular corticosteroid injections can be applied to help diminish complaints. Am J Sports Med., 2009;37:929–936, OH, J. H. et al., The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. Clinicians should keep in mind the utilization of MRA may promote the overdiagnosis of asymptomatic (or clinically irrelevant) SLAP lesions and thus exercise best clinical judgment in ordering specific advanced imaging modalities. reported surprising trends after mining the American Board of Orthopaedic Surgery (ABOS) Part II database. [ 2] The authors. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. previously demonstrated that the tendon of the long head of the biceps contains a complex network of sensory and sympathetic nerve fibers. It can also be caused by repetitive motions. The resulting tear of the labrum can then be debrided or fixed depending upon the severity of the tear. Arthroscopic all-intra-articular decompression and labral repair of paralabral cyst in the shoulder. Schrøder CP, Skare O, Gjengedal E, Uppheim G, Reikerås O, Brox JI. 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). [28], Finally, the Buford complex is a congenitally absent anterosuperior labrum plus a thickened cord-like middle glenohumeral ligament. [25] later clarified these attachment types and included their relationships with the glenoid attachment of the glenohumeral ligaments. Also suprascapular neuropathy secondary to cyst compression in the spinoglenoid notch may occur in association with SLAP tears. SLAP tears are a common coexisting injury in patients with other shoulder pathologies, and they do not always account for the primary cause of symptoms. [32]The indications for biceps tenodesis as the index procedure for a symptomatic SLAP lesion depends on: If a biceps tenodesis is performed a minimum of 10 weeks is recommended without biceps activity to allow the repaired soft tissue to fully incorporate into the bone tunnels.[11]. American journal of sports medicine,2009;37:2252-2258. 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. The examiner then applies terminal external rotation until resistance is appreciated. [Level 2-3]. Clinicians should focus on the potential relevance of the SLAP lesion as it attributes to the specific patient’s pain and dysfunction. Return to play after treatment of superior labral tears in professional baseball players. The examiner places one hand on the joint line of the shoulder and the other hand on the elbow. By weeks five to six, strengthening exercises are started, and active external rotation and abduction motions are allowed. 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. Previous authors have advocated for the use of simple versus mattress sutures and the option for knotless fixation devices to minimize the risk of having a bulky knot create symptoms postoperatively.[51][52]. Tear pattern involves larger superior labral flaps without detachment of the LHBT insertion. Typically, SLAP lesions are from about 10:00 - 2:00 if you were to visualize a clock face. Burkhart previously described demonstrating a ‘‘peel-back’’ sign during arthroscopy. The palm is on the anterior aspect of the contralateral shoulder, with the elbow flexed to 90 degrees. 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. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). SLAP tears may present in a relatively nonspecific fashion and association with other shoulder pathologies. At first the clinician can test the tenderness to palpation at the rotator interval which can be helpful in the diagnostic procedure. [38] [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]. [2]Regaining GIRD is a crucial aspect in the rehabilitation of SLAP lesions. The rotator interval is an anatomic space between the Supraspinatus tendon, the Subscapularis tendon and the processus coracoideus. When refering to evidence in academic writing, you should always try to reference the primary (original) source. J. An honest dialogue of outcomes with each patient is vital before selecting the appropriate intervention. These exercises are: These exercises, with increasing low to moderate activity, can be applied in the early and intermediate phases of nonoperative and postoperative treatment for patients with proximal biceps tendon disorders and SLAP lesions. Neri BR, ElAttrache NS, Owsley KC, Mohr K, Yocum LA. Patterson BM, Creighton RA, Spang JT, Roberson JR, Kamath GV. A total of four types of superior labral lesions involving the biceps anchor have been identified. [20], Erickson et al. Superior Scapes, Liverpool, New York. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. The location you tried did not return a result. Maffet MW, Gartsman GM, Moseley B. Variability in the anatomy of the biceps anchor and tendinous origin translates to varying levels of strain on the superior labrum. Am. This decreases the normal shoulder function. Phys Ther., 1986;66:1855-1865, CARMICHAEL S.W. A structured rehabilitation program and open communication between the interprofessional team, including primary care, sports medicine, orthopedics, physical therapists, and specialty trained nurses, are important to ensure a step-wise approach is followed to achieve maximum patient satisfaction and function. Superior labrum is more weakly attached to glenoid than inferior labrum. and Maffet et al. A SLAP tear can be caused by trauma to the shoulder. Journal of orthopaedic & sports physical therapy, 2009;39(2): 2009, MORGAN CD et al., Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears, Arthroscopy 1998 Sep;14(6):553-65, GASKILL T.R., The rotator interval: pathology and management, Journal of Arthroscopy and Related Surgery 2011, vol. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. et al., A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions. http://creativecommons.org/licenses/by-nc-nd/4.0/. SLAP-lesion-specific physical examination tests have been developed to improve clinical acumen. Anti-inflammatory medications, cryotherapy/cooling/ice application, rest and activity modification. A positive test is noted if the patient reports pain over the bicipital groove and/or subluxation of the LHB tendon. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Passive and active-assist forward elevation encouraged, may progress limitations depending on surgeon preference. et al., The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions. Furthermore, biceps tenodesis may provide a viable alternative for the salvage of a failed SLAP repair. SLAP (superior labrum anterior and posterior) tears are injuries to the uppermost part of the labrum, where the biceps tendon attaches to the shoulder. Kwak SM, Brown RR, Resnick D, Trudell D, Applegate GR, Haghighi P. Anatomy, anatomic variations, and pathology of the 11- to 3-o'clock position of the glenoid labrum: findings on MR arthrography and anatomic sections. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Important variations in the normal anatomy of the labrum have been identified. 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 Journal of Manual & Manipulative Therapy, 2001;9(2):71 – 83, WILK K.E. Results are widely varied in these athletes, demonstrating the return to the prior level of sport between 7% and 84%. Stress distribution in the superior labrum during throwing motion. [19][20][4] Subsequently, as the understanding of the injury continued to unfold, rates of repair have steadily declined. Given the clinical complexity of SLAP injuries and concomitant shoulder pathologies, early consultation with an orthopedic surgeon is encouraged. Ascertaining patients’ goals is also paramount as post-intervention physical demands and expectations of a high-level athlete are likely different than the aging population. Clinicians should obtain a comprehensive history should when evaluating patients presenting with acute or chronic shoulder pain. The patient stands with his or her involved arm flexed 90 degrees at the elbow and abducts the shoulder in the scapular plane to above 120 degrees. [47] Moreover, it is important to recognize other shoulder pathologies, such as shoulder impingement (external or internal), rotator cuff syndrome, LHBT tendinopathy, and acromioclavicular (AC) arthritis, are all common pain generators in the middle-age population. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. A detailed neurovascular examination is performed and documented, complete with muscle strength testing. Incidence of SLAP lesions in a military population. It is essential to understand that not all SLAP tears are created equal. [24] These four types were described based on macroscopic observation of 105 cadaveric shoulder specimens: Tuoheti et al. Scapulothoracic motion and scapular winging should also be evaluated during active and passive motion. [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]. Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction. Immediately post operative Patient will remain in an immobilizer for four weeks. Type II SLAP tear pattern plus middle and inferior IGHL compromise, Tear pattern seen in the setting of complex shoulder instability presentations, Type II SLAP tear pattern plus additional cartilage injury adjacent to the bicipital footplate, Mechanical symptoms: popping, locking, catching with various movements and activity, History of any sudden, jerking force to the shoulder with an associated onset of pain, History of or current episodes of shoulder instability, History of or current sport-specific participation, Including the level of competition (e.g., professional, collegiate, recreational). A 2017 level III case-control study highlighted the potential risk factors for revision surgery following SLAP repair, with the inclusion of nearly 5000 patients in the database query[58]. Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms. National trends in the diagnosis and repair of SLAP lesions in the United States. [28] It is generally recognized that the majority of patients with symptomatic SLAP lesions will fail conservative management, particularly throwers. 2009 Oct-Dec; 43(4): 342–346, WILK K.E. Background:Superior labral anterior and posterior (SLAP) lesions are common injuries in overhead athletes. Nonoperative PT regimens focused on correcting for scapular dyskinesia and glenohumeral internal rotation deficit (GIRD).[49]. [46]. Horizontal mattress with a knotless anchor to better recreate the normal superior labrum anatomy. The Neviaser portal is often utilized and established under direct visualization once confirming the appropriate trajectory are achieved. [11], It is important to keep in mind that the scapula is an important factor during shoulder movements. This increase constituted a jump in case volume reporting from 765 to 4313 annual SLAP repairs. Patient complaint of pain is not a good gauge for progression. A standard detailed history is required, as with all patients presenting to the clinic. Also, a wide array of implant options are available depending on surgeon preference. MRI and MR arthrography (MRA) are commonly used imaging modalities to detect a SLAP lesion. They found that tenodesis is superior to the repair of type II SLAP tears in older population. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. [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. Jobe FW, Giangarra CE, Kvitne RS, Glousman RE. Brockmeier SF, Voos JE, Williams RJ, Altchek DW, Cordasco FA, Allen AA., Hospital for Special Surgery Sports Medicine and Shoulder Service. In SLAP repairs with unstable patterns, a more gradual approach is taken. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. [1] In 1985, Andrews first described superior labral pathologies, and Snyder later coined the term “SLAP lesion” because of the location and characteristic tear extension patterns. As mentioned, this concept can also be applied to the young, athletic population as well. Para ayudar a estabilizar el hombro, hay un anillo de tejido firme, llamado labrum, alrededor de la cavidad del hombro. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. [13][12]It changes the activation of the scapular stabilising muscles. A paralabral cyst found on MRI is a diagnostic clue for a SLAP tear. Summarize interprofessional team strategies for improving care coordination and communication to enhance outcomes for patients affected by superior labral anterior to posterior (SLAP) lesions. BackgroundPrevious studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in. Skeletal Radiology, 2014;43: 1065 – 1070, POWELL S.E. [17] Anatomical variations such as a Buford complex, a thickened middle glenohumeral ligament (MGHL), and absent anterosuperior labrum may be confused with a SLAP tear as well. Superior labrum anterior posterior lesions.Available: PROVENCHER M.T. An interprofessional team approach involving clinicians (including PAs and NPs), therapists, and orthopedically-trained nurses will provide the best results. 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. [39] initially described four types of attachment patterns of the long head of the biceps tendon (LHBT) to the superior glenoid rim and the superior labrum. Superior labrum anterior and posterior lesions of the shoulder: incidence rates, complications, and outcomes as reported by American Board of Orthopedic Surgery. [39]. Snyder et al. [40]. Tenodesis patients are protected for four weeks, and avoidance of supination and flexion of the elbow is recommended. Type I concerns degenerative fraying with no detachment of the biceps insertion. Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. The true AP image is taken with the patient rotated between 30 and 45 degrees offset the cassette in the coronal plane. 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. A positive test results when the patient cannot hold the hand against the shoulder as the examiner applies an external rotation force. They may complain of night pain, which is a common complaint with several shoulder pathologies. - Clinical Presentation and Follow-up of Isolated SLAP Lesions of the Shoulder (SS-04) - Classification and Treatment: - labrum is assessed, including stability of the biceps labral attachment, as well as biceps tendon; - SLAP tears will show more than 5 mm of exposed superior glenoid bone and often a peel back sign; - peel back sign: In most cases Physiopedia articles are a secondary source and so should not be used as references. The age of the patient has an impact on the superior labrum. Outcomes after arthroscopic repair of type-II SLAP lesions. Understanding the rigorous rehabilitation required from advanced procedures helps the patient understand what is expected on their road to recovery. The developmental anatomy of the neonatal glenohumeral joint. But if all three tests are positive this will result in a specificity of about 90%. [7] Internal impingement can also result from rotator cuff tears via chronic posterosuperior or anterosuperior migration/subluxation of the humeral head.[8]. Kim TK, Queale WS, Cosgarea AJ, McFarland EG. [23][27] The most common complications after surgical fixation are residual pain and stiffness. Unlike Bankart lesions and ALPSA lesions, they are not usually (20%) associated with shoulder instability.[1]. [56], Clinicians should recognize that inferior outcomes have been demonstrated in the literature following revision arthroscopic SLAP repairs and high-level (i.e., professional) overhead athletes. ( The long head of the biceps tendon attaches in the glenoid as part of the labrum at roughly 12:00. [13][14], The glenoid labrum is often involved in shoulder pathology. Identify the etiology of superior labrum lesions (SLAP tears) medical conditions and emergencies. Characteristics of LHBT-associated pathologies have been previously described and may include any combination of the following: Additionally, a thorough history includes a detailed account of the patient’s occupational history and current status of employment, hand dominance, history of injury/trauma to the shoulder(s) and/or neck, and any relevant surgical history. [15][16], Nonoperative management has efficacy for many symptomatic SLAP tears and should be considered for initial treatment. A Treatment-Based Algorithm for the Management of Type-II SLAP Tears. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. Int. The goal of physical therapy (PT) modalities should be to treat any underlying pathologic shoulder biomechanics that may have been present at baseline before the acute injury. [12]They may also report a loss of velocity and accuracy along with discomfort in the shoulder. Advances in contemporary diagnostic capabilities and arthroscopic management techniques have led to evolving management paradigms since the original descriptions of SLAP-type lesions. Suprascapular nerve compression from a paralabral cyst may occur. [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. [8], Throwers can have repetitive microtraumata. SLAP lesions demonstrate a predilection for young laborers, overhead athletes, and middle-aged manual laborers. A structured advancement of strengthening sports specific rehabilitation and dynamic exercises are continued for several months. et al., Non operative treatment of superior labrum anterior posterior tears - improvements in pain function and quality of life. The results of biceps reinsertion are disappointing compared with biceps tenodesis. [21]However in another study by Alpert et al., it is shown that type II SLAP repairs using suture anchors can yield good to excellent results in patients older and younger than age 40. Johannsen AM, Costouros JG. Traumatic injuries commonly occur following acute, index events based on one of the following mechanisms:[2], Compared to the acute, traumatic SLAP injuries, the overhead athlete is more likely to present with attritional-based etiologies. 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. [38] Until now only one study looked at results from physical management on SLAP lesion. The superior labrum and biceps anchor could theoretically be gradually lifted off the glenoid as a result of chronic repetitive superior translation of the humeral head on the glenoid rim. el slap es una lesión en el hombro (2), específicamente en la parte superior del labrum glenoideo y es conocida como "slap" debido a sus siglas en inglés (superior labrum anterior to posterior) es decir que el labrum ha sufrido una rotura o se ha desgarrado de anterior hacia posterior y por lo general se debe a la tracción que ejerce el tendón de … Type VII: a superior labrum and biceps tendon separation that extends anteriorly, inferior to the middle glenohumeral ligament. SLAP Lesions: Trends in Treatment. Sling immobilization until 4 weeks postoperative, Early shoulder pendulum exercises, periscapular muscle activation exercises. et al., The Diagnosis, Classification, and Treatment of SLAP Lesions. The findings can be rather subtle, especially in obese patients. Superior labral anterior to posterior (SLAP) lesions constitute a recognized clinical subset of complex shoulder pain pathologies. Between week 4 and 8, internal and external rotation ROM are progressively increased to 90° of shoulder abduction. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Initially rest post the acute (or acute-on-chronic) injury should be implemented. In these clinical scenarios, the recommendation is to reassure the patient and educate them regarding the high incidence rate of “incidental” or “clinically irrelevant” SLAP injuries. SLAP lesions first gained recognition in the 1980s. Multiple exam maneuvers point to either labral involvement via impingement or compression mechanisms. Maffet MW, Gartsman GM, Moseley B. A cordlike middle glenohumeral ligament without tissue at the anterosuperior labrum. Weber SC, Martin DF, Seiler JG, Harrast JJ. J. et al., Shoulder rotator strength and torque steadiness in athletes with anterior shoulder instability or SLAP lesion. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. More research is necessary regarding the histologic characterization of the superior labrum-LHBT complex. Glenohumeral internal rotation deficit (GIRD) is a common associated finding in throwing athletes. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. Utilizing dedicated formal PT regimens can help ensure each “SLAP tear” diagnosis is most appropriately managed to help mitigate the risks of inferior patient outcomes. The determination of appropriate anchor placement depends on the predominant region of instability regarding the superior labral-biceps tendon complex. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Some tests isolate the tension placed on the superior labrum by the biceps via provocative maneuvers in active and passive forms. Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ. A SLAP lesion is mainly caused by a fall on an outstretched arm where there is an important superior compression on the labrum which causes a tear of the labrum. Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. In a labrum SLAP tear, SLAP stands for superior labrum anterior and posterior. Initial physical examination includes visual inspection for gross asymmetry and muscle atrophy. Secondary to fraying related to Internal Shoulder Impingement. [10]The majority of patients with SLAP lesions will also complain of: Athletes performing overhead movements, especially pitchers, may develop “dead arm” syndrome in which they have a painful shoulder with throwing and can no longer throw with pre-injury velocity. Type I concerns degenerative fraying with no detachment of the biceps insertion. In a SLAP injury, the top (superior) part of the labrum is injured. Access free multiple choice questions on this topic. A positive test is a pain or a painful pop over the anterior shoulder near the bicipital groove region.
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