An mri is usually performed if a slap tear is suspected, but arthroscopic surgery is the best way to confirm this injury. Imaging the glenoid labrum and labral tears rsna publications. Using arthroscopic surgical techniques, the superior labrum is mobilized along the entire area of detachment using a 4. In swimming, this injury is one of many shoulder injuries contributing to shoulder pain. Firstly, the methodological quality of the included studies was generally low. The shoulder labrum is a ring of cartilage around the shoulder socket that stabilizes the head of the upper arm bone. Threedimensional isotropic shoulder mr arthrography. The higher success rate of arthroscopic suture anchor repair of slap lesions compared with open capsulolabral reconstruction suggests that slap lesions are the usual cause of the dead arm syndrome. However, more extensive labral tears do occur, some of which may be progression of preexisting slap lesions, or its combination with a bankart lesion slap type v. Jan 27, 2016 tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been dis. The journal of arthroscopic and related surgery 64. While bankart 1 is given credit for describing injury to the anteriorinferior glenoid labrum in 1938, the first description of injuries to the superior glenoid labrum in throwing athletes was in 1985 by andrews et al.
Slap lesions occur in overhead athletes due to chronic repetitive stress. It is difficult to identify a slap tear by symptoms alone. The glenoid labrum enhances shoulder stability in 4 distinct ways. An slap lesion is defined as a lesion of the superior labrum, which typically originates at the site of attachment of the lhbt biceps anchor and may extend to the anterior or posterior portions.
Bankart tear tear of the anteroinferior glenoid labrum. Slap lesions are a unique type of labral tear in the shoulder. Slap tear shoulder injury and treatment sportshealth. One research group suggests that combining two of three sensitive tests. Additionally, the authors found that the creation of a slap lesion resulted in a 102% to 120% increase in the amount of strain recorded in the anterior superior band of the inferior glenohumeral ligament. The diagnosis of these lesions is difficult due to vague symptoms and high degree of. Superior labral anterior posterior slap lesions of the glenoid labrum. Evaluation of oxford instability shoulder score, western. The labrum is the cuff of cartilage that extends the socket part of the shoulder blade to better accept the ball end of the arm bone.
This is where the top part of the arm bone the head of humerus, which is shaped like a ball, fits in a socket on the front of the shoulder blade glenoid fossa. Sep 15, 2010 the authors suggest that given these results yergasons test is the only clinical test that demonstrates a clinically significant plr for the diagnosis of slap lesions. Slap tear itself accounts for 8090% of labral pathology in stable shoulder but its only found in 6% on arthroscopy. Mri in shoulder instability and slap lesions springerlink. Pathology of the superior aspect of the glenoid labrum slap lesion poses a significant challenge. Slap lesion is mostly combined with a lesion of the proximal head of the biceps because it attaches on the. Nonslap lesions the tear tends to be unstable and degenerative in nature. This article describes the structure and function of the labrumbiceps slap lesions. Coexisting injuries may confound the clinical findings. Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles, ligaments and a rim of cartilage called the labrum to stabilise it during movement. Slap lesion repair emily cotey, emily hurysz, and patrick schroeder abstract slap lesion, which stands for superior labrum anterior and posterior, is a detachment tear of the superior labrum that originates posteriorly to the tendon of the long head of the biceps and extends anteriorly. The goal of surgical repair of a slap lesion is to obtain a strong repair that allows the patient to aggressively rehabilitate the shoulder and return to full activities or sports competition. Interestingly, combining all four tests did not improve the or for detecting isls or csls. The fibers of the biceps tendon blend with the superior labrum continuing posteriorly.
Examination of the biceps tendon and superior labrum. The most common clinical complaints were pain, greater with. The mechanical characteristics of suture anchors are more favorable in resisting the pathologic forces responsible for the peelback mechanism. When the shoulder is placed in a position of maximal external rotation, the rotation produces. Slap lesions of the shoulder pain is usually aggravated by overhead activ ity and may be associated by clicking, popping, stiffness, and glenohumeral instability 9. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. Some slap lesions can be simply debrided and cleaned, whilst most need repairing depending on the severity of the lesion. Efficacy of labral repair, biceps tenodesis, and diagnostic. The authors have identified a number of limitations to this research. Superior labral anterior posterior lesions of the shoulder. The procedures include labral repair or biceps tenodesis. When throwing a ball or other object, or performing similar motions eg, swinging a hammer, the shoulder is forcefully abducted and externally rotated during the cocking phase. This is accomplished through a variety of manual resistance and end range.
Slap tear injuries can cause feelings of unsteadiness, as though the shoulder will pop out of its socket. However, the results in throwing athletes are less successful with a significant amount. Mri is useful if the diagnosis of instability is uncertain, in multidirectional instability, or if there may be accompanying pathology, including rotator cuff pathology, biceps tendon pathology, slap lesions and isolated ligamentous or capsular injuries. Evaluation of oxford instability shoulder score, western ontario shoulder instability index and euroqol in patients with slap superior labral anterior posterior lesions or recurrent anterior dislocations of the shoulder. A slap tear or lesion occurs when there is damage to the. A slap tear is a torn piece of cartilage in the inner portion of the shoulder joint. Superior labrum anterior posterior slap tears uptodate. The second reason slap lesions are difficult to diagnose is that there are many mechanisms that can produce slap lesions, so the patients history may not be helpful in making the diagnosis.
Prevention strong shoulder muscles remain the best defence against shoulder injuries. I have a slap lesion a cartilage tear on the rim of the shoulder socket having injured my shoulder seven months ago. In addition, the rotator cuff muscles are essential to ensure dynamic shoulder. The most prevalent is type ii which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Diagnostic performance of mr arthrography in the assessment of superior labral anteroposterior lesions of the shoulder.
Slap v lesion mr arthrography of the shoulder radiology. Slap lesion of the shoulder joint cooper university. Slap lesions are becoming a more recognized cause of shoulder pain and disability. Acromion shoulder blade scapula clavicle collarbone humerus rotator. Slap lesion repair emily cotey, emily hurysz, and patrick. A slap tear is when there is damage to the ring of cartilage on the socket of the shoulder joint, known as the labrum. It stands for superior labral anterior to posterior tear, meaning a tear of the upper rim of the labrum from front to back. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective nonrandomised study.
Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. Anatomy your shoulder is a ballandsocket joint made up of three bones. Repetitive overhead activity has been hypothesized as a common mechanism for producing slap lesions. Mar 22, 2018 background on slap lesions superior labral anterior posterior slap lesion is a pathology where the superior labrum, anterior and posterior biceps anchor detach. The biceps tendon attaches at the top of the labrum. Background slap tear injury is tear of superior part of glenoid labrum in the region of the insertion of the biceps tendon. This detachment leads to instability, pain, and functional decline. Superior labrum anterior posterior slap lesions can also be associated with other shoulder pathology. A 30 percent increase of maximum external rotation was achieved with a gradual increase in torque applied to the shoulder. Concurrent shoulder injuries are often present including rotator cuff tears, cystic changes.
Pdf the recognition and treatment of superior labral slap lesions. I dont want to have surgery, but not climbing is bringing me. The associated lesions are also treated such as labrum and ligament lesions with instability. Injury occurs from inferior traction on the shoulder, as well as excessive tension on and twisting of the long head of biceps tendon lhb at its insertion along the superior labrum that occurs during the cocking motion of throwing 2, 3. A bankart lesion is the most common injury sustained with traumatic dislocation, but other injuries can occur. Mri approach to the diagnosis of slap lesions mri and mr arthrography play key roles in the noninvasive diagnosis of slap tears.
Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been discussed, defined, and investigated since andrews et al1 first described this. Injury to the superior aspect of the glenoid labrum slap lesions poses a significant. Anterior shoulder instability with concomitant superior. Examination of the biceps tendon and superior labrum anterior.
Slap lesions were not recognized until the 1980s when keyhole surgery of the shoulder was starting to be performed. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective non. The authors suggest that given these results yergasons test is the only clinical test that demonstrates a clinically significant plr for the diagnosis of slap lesions. Thus, in the presence of a superior labral lesion, similar to a type ii slap lesion as described in. This motion performed while the hand carries a weight places stress on the labrum. The term slap stands for superior labral tear anterior to posterior. A slap lesion typically occurs from a fall on an outstretched hand, sudden deceleration or traction forces such as catching a heavy falling object, and anterior and posterior instability. The shoulder socket is very shallow, similar to a golf tee, to allow for lots of movement. Surgery for type ii slap superior labral anterior posterior lesions of the shoulder is a promising but unproven treatment. These mechanisms of injury are also associated with a. Of 544 shoulder arthroscopy procedures performed, 9 26%. Lastly, there is a high incidence of associated pathology and injuries with slap lesions, including rotator cuff disorders partialthickness rotator cuff tears, 40% to 29%, and full.
The labrum deepens the golf tee to help make the shoulder more stable. Many slap lesions occur in throwing or overhead athletes. These lesions have come into public awareness because of their frequency in athletes involved in overhead and throwing activities in turn relating to relatively recent description of labral injuries in throwing athletes, 4 and initial definitions. This is a very common diagnosis for shoulder injuries. However, the results in throwing athletes are less successful with a significant amount of. Stretching of the anterior capsule in external rotation created anterior laxity. Pdf superior labral anterior posterior lesions of the.
You may be a baseball pitcher or the parent of a baseball player, likely a pitcher, doing your research looking for that nonsurgical alternative that will save next season for your son. A slap tear or lesion occurs when there is damage to the superior uppermost area of the labrum. It can be painful andor limit movement in the shoulder, especially overhead motions. A slap tear is an injury to the superior part of the labrum in the shoulder. Slap lesions are often seen in combination with other shoulder problems and this makes it difficult to diagnose. Signs and symptoms poorly localized pain in and around the.
The term slap lesion is used to describe anatomic lesions of the superior glenoid labrum and biceps anchor. Slap stands for superior labrum anterior and posterior, which defines the anatomical location of the injured area. Mr imaging of slap lesions open orthopaedics journal. Injury to the superior aspect of the glenoid labrum slap lesions poses a significant challenge. Lesions of the superior labrum anterior and posterior slap to the biceps tendon. If you have associated instability, perhaps with a labrum tear in the front of the shoulder, you may also feel shifting in the shoulder. A slap tear is an injury to a part of the shoulder joint called the labrum. All 10 slap lesion subtypes are characterized by tearing of the. There many different variations of slap tears, which have different levels of severity and treatment strategies. These injuries can usually be diagnosed on an mrarthrogram or ctarthrogram. The glenoid labrum is most commonly injured by a fall or from repetitive overhead movements, such. Slap tear refers to a specific injury of the superior portion of the glenoid. Snyder and coworkers described a superior glenoid labral lesion that begins posteriorly and ends anteriorly, and coined the term slap. A type viii slap lesion is a slap extension along the posterior glenoid labrum as.
A slap tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint. Slap lesion of the shoulder joint cooper university health care. Before the use of shoulder arthroscopy and magnetic resonance imaging mri in the diagnosis and management of shoulder problems, glenoid labrum lesions were underappreciated. Slap lesions of the shoulder are challenging to diagnose by clinical means alone. This attachment can lead to labral injury during shoulder motions in the. Repairing a slap tear without surgery if you are reading this article you are likely someone very involved in sports or you have a physically demanding job. Buckethandle tear of the anterior superior glenoid labrum associated with bicipital tendinosis. A specific pattern of injury to the superior labrum of the shoulder was identified. Signs and symptoms poorly localized pain in and around the shoulder exacerbated with overhead and twisting tasks. Slap lesions were first classified by snyder et al.
A slap lesion is a tear that occurs where the tendon of the biceps muscle meets the labrum. Usually an mriarthrogram is required to demonstrate the s. The four types of slap lesions snyder classification. Background on slap lesions superior labral anterior posterior slap lesion is a pathology where the superior labrum, anterior and posterior biceps anchor detach. These mechanisms include a fall upon the extremity with an outstretched arm, workrelated injuries, shoulder dislocation, and overuse due to overhead. Slap lesions the tear is located in the top portion of the labrum at the front of the biceps tendon to the back of the joint socket. Associated tear of the anterior inferior labrum bankart lesion with superior extension of. Mghl courses deep to the subscapularis tendon to blend and. Pdf imaging of glenoid labrum lesions researchgate. Both mri and mra can be utilized in making the diagnosis with the coronal images being the most sensitive.
The case demonstrates the superiority of the mr arthrography in detection of slap lesions. Fall onto an outstretched hand repetitive overhead. Slap lesion and cortisone i have a slap lesion a cartilage tear on the rim of the shoulder socket having injured my shoulder seven months ago. Diagnostic utility of clinical tests for slap lesions.
145 1371 155 1449 1051 1266 238 455 693 317 350 353 555 66 252 1275 1362 1325 925 108 482 645 1025 689 1060 1446 1444 1271 178 855 770 888 370 424 249