SLAP lesions: current controversies

Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear. Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons. First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous. Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries. Third, SLAP lesions have no specific associated pain pattern. Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics. Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.

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Arthroscopic shoulder assessment in Turkish amateur boxers

Open Medicine ◽

10.2478/s11536-008-0079-x ◽

2009 ◽

Vol 4 (3) ◽

pp. 358-362

Author(s):

Hüseyin Özkan ◽

İbrahim Yanmış ◽

Mustafa Kürklü ◽

Ali Şehirlioğlu ◽

Servet Tunay ◽

...

Keyword(s):

Physical Examination ◽

Clinical Findings ◽

Subacromial Impingement ◽

Shoulder Injuries ◽

Pathological Findings ◽

Glenoid Labrum ◽

Arthroscopic Findings ◽

Shoulder Region ◽

Grade 3 ◽

The Brain

AbstractThe most common injuries reported in the literature regarding the sport of boxing are to the brain, eyes, kidneys and hands. Shoulder injuries have not been fully reported in the literature until recently, as a result we aimed to present our arthroscopic findings in amateur boxers. Ten amateur boxers with complaints of pain in the shoulder region and decreased performance during sportsplay were enrolled. They were evaluated by physical examination, radiology and arthroscopy. There were no clinical findings of instability. One patient was found to have subacromial impingement; six had crepitation at various degrees during shoulder movements. At arthroscopy, all patients had a variety of pathological findings. Five patients had Grade 1, three had Grade 2, and two had Grade 3 chondropathy. Various degrees of fraying of the anterosuperior and posterosuperior regions of the glenoid labrum were noted in all cases. Three patients had superior labrum anterior and posterior lesions, one patient had a posterior labroligamentous lesion, and one had chondral erosion in the anterosuperior portion of the humeral head. In conclusions, although the injury mechanism of the shoulder during boxing is unknown, this study shows that shoulder complaints in boxers should be considered as possible indicators of serious intra-articular lesions.

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Syncope

Journal of Intensive Care Medicine ◽

10.1177/088506669200700303 ◽

1992 ◽

Vol 7 (3) ◽

pp. 138-148 ◽

Cited By ~ 1

Author(s):

Kevin H. Silver ◽

Joseph S. Alpert

Keyword(s):

Intensive Care ◽

Surgical Treatment ◽

Physical Examination ◽

Intensive Care Units ◽

Diagnostic Tests ◽

Venous Return ◽

Clinical Presentation ◽

Diagnostic Tools ◽

Peripheral Vascular ◽

Conduction Disturbances

Syncope is a common admitting diagnosis to intensive care units; however, in half the cases, the etiology goes undiagnosed. The prognosis is adversely affected in patients with a cardiogenic etiology. We discuss the clinical presentation and pathophysiology of cardiovascular causes of syncope (including arrhythmia and conduction disturbances, myocardial disorders, and valvular disorders), vascular causes (obstruction and decreased venous return), peripheral vascular causes (arterial and venous), and noncardiovascular causes (neurological and hematological). A thorough history and physical examination are the best diagnostic tools. In addition, electrocardiograms and 24-hour telemetry monitoring are also useful. Other diagnostic tests should be ordered judiciously, depending on the findings of the initial evaluation. Medical or surgical treatment is directed at the underlying cause.

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Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions

The Surgery Journal ◽

10.1055/s-0037-1606829 ◽

2017 ◽

Vol 03 (04) ◽

pp. e154-e162 ◽

Cited By ~ 5

Author(s):

Lyndsay Somerville ◽

Kevin Willits ◽

Andrew Johnson ◽

Robert Litchfield ◽

Marie-Eve LeBel ◽

...

Keyword(s):

Physical Examination ◽

Slap Lesion ◽

Measurement Properties ◽

Likelihood Ratios ◽

Diagnostic Challenge ◽

Slap Lesions ◽

Arthroscopic Examination ◽

Physical Tests ◽

Sensitivity Specificity ◽

Slap Tear

Purpose Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study. Methods We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis (“certain the diagnosis is absent/present,” or “uncertain requires further testing”). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions. Results Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I–V) as disease positive, none of the tests was sensitive (10.3–33.3) although they were moderately specific (61.3–92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5–38.7) and specificity (70.6–93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and specificity 64.7%). Conclusion Our study demonstrates that the physical examination tests for SLAP lesions are poor diagnostic indicators of disease. Performing a combination of tests will likely help, although the magnitude of the improvement is minimal. These authors caution clinicians placing confidence in the physical examination tests for SLAP lesions rather we suggest that clinicians rely on diagnostic imaging to confirm this diagnosis.

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Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2013.09.030 ◽

2014 ◽

Vol 23 (7) ◽

pp. 1059-1065 ◽

Cited By ~ 75

Author(s):

Eugene T.H. Ek ◽

Lewis L. Shi ◽

Jeffrey D. Tompson ◽

Michael T. Freehill ◽

Jon J.P. Warner

Keyword(s):

Surgical Treatment ◽

Type Ii ◽

Biceps Tenodesis ◽

Slap Lesions ◽

Superior Labrum ◽

Anterior Posterior

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The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery?

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211043468 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110434 ◽

Cited By ~ 1

Author(s):

Patrick Gendre ◽

Pascal Boileau

Keyword(s):

Surgical Treatment ◽

Recovery Period ◽

Case Series ◽

International Level ◽

Shoulder Injuries ◽

Biceps Tenodesis ◽

Independent Observer ◽

Previous Level ◽

High Level ◽

Return To Competition

Background: The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented. Purpose: To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%). Results: After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%. Conclusion: Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics.

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Effectiveness of biceps tenodesis versus SLAP repair for surgical treatment of isolated SLAP lesions: A systemic review and meta-analysis

Journal of Orthopaedic Translation ◽

10.1016/j.jot.2018.09.002 ◽

2019 ◽

Vol 16 ◽

pp. 23-32 ◽

Cited By ~ 1

Author(s):

Min Li ◽

Atik Badshah Shaikh ◽

Jinbo Sun ◽

Peng Shang ◽

Xiliang Shang

Keyword(s):

Surgical Treatment ◽

Meta Analysis ◽

Systemic Review ◽

Biceps Tenodesis ◽

Slap Lesions ◽

Slap Repair

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Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

Methods of Information in Medicine ◽

10.1055/s-0038-1634634 ◽

1996 ◽

Vol 35 (01) ◽

pp. 41-51 ◽

Cited By ~ 3

Author(s):

F. Molino ◽

D. Furia ◽

F. Bar ◽

S. Battista ◽

N. Cappello ◽

...

Keyword(s):

Clinical Presentation ◽

Clinical Information ◽

Diagnostic Value ◽

Clinical Findings ◽

Clinical Documentation ◽

Data Set ◽

Knowledge Based ◽

Number Of Patients ◽

Support Tools ◽

Aided Diagnosis

AbstractThe study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMACBME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

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