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SLAP Lesions |
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Superior Labrum,
Anterior and Posterior (SLAP) Lesions
Evan Hermanson, MD
September 16, 2004
Anatomy of Shoulder
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Intrinsically unstable
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Large humeral head, small glenoid cavity
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Relies on surrounding soft tissue
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Capsule
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Surrounding muscles
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Glenohumeral ligaments
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Labrum
Labrum
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Fibrocartilaginous tissue
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Distinct from adjacent hyaline cartilage
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Contributes to shoulder stability
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Increases surface & and depth of glenoid cavity
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Provides a bumper effect
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Provides attachment for other stabilizing structures
Long Head of Biceps
Typical History?
Traction
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Sudden pull
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Anterior
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Inferior
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Superior
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Throwing
Compression
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Fall on outstretched arm in slight flexion and abduction
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Direct blow to the shoulder
Common complaints
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Vague shoulder pain
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Worse with overhead activities
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Mechanical symptoms of catching, locking, or grinding.
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Confused with impingement-type pain.
Physical
Examination
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No physical findings specific for SLAP lesions
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Snyder’s Biceps Tension Test
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Snyder’s Compression-Rotation Test
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Anterior Slide Test
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Crank Test
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O’Brien’s Active Compression Test
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Pain Provocation Test
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Biceps Load Test
Compression-Rotation Test
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Patient supine
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Shoulder abducted 90
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Elbow flexed 90
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Compression force and rotation (similar to MacMuray’s)
Anterior Slide Test
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Hands on hips and thumbs pointed posteriorly
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Examiner’s hands across top of shoulder and the other behind the
elbow
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Force applied to elbow and upper arm while patient pushes back
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Pain in front of shoulder and/or pop or click
Crank Test
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Patient upright and arm elevated 160
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Load joint along axis of humerus
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Humeral rotation
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Positive if:
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Pain +/- click
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Reproduces symptoms
O’Brien’s Active
Compression Test
O’Brien’s Active
Compression Test
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Fully supinate
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Downward force
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+ if pain elicited in pronation and reduced or eliminated in
supination
Pain Provocation
Test
Pain Provocation
Test
Biceps Load Test
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Supine
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Arm abducted 90
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Forearm supinated
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Apprehension test
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When patient becomes apprehensive, resist elbow flexion
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+ if no change or apprehension worse
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- if apprehension improves
MRI Findings –
Coronal Oblique
MRI Findings -
Axial
Sublabral Hole
Buford Complex
Bankart Lesion
Treatment Type 1
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Debridement of labrum
Treatment Type II
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Repaired
Treatment Type III
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Resection of bucket-handle labral fragment
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Inspection of biceps anchor
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Repair if unstable
Treatment Type IV
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Resection of bucket-handle labral fragment
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> 30% involvement of the biceps tendon, consider repairing the
tendon, releasing it and repairing the labrum, or biceps tenodesis
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