Superior labrum-SLAP lesion

2011 ◽  
Author(s):  
Stefaan Van de Perre
Keyword(s):  
Slap Lesion ◽  
Superior Labrum

scholarly journals Special Physical Examination Tests for Superior Labrum Anterior-Posterior Shoulder Tears: An Examination of Clinical Usefulness

2013 ◽  
Vol 48 (6) ◽  
pp. 856-858 ◽  
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Confidence Intervals ◽  
Biceps Tendon ◽  
Tendon Injury ◽  
Slap Lesion ◽  
Superior Labrum ◽  
Posterior Shoulder ◽  
Anterior Posterior

Reference/Citation: Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior-posterior shoulder injuries are clinically limited and invalid: a diagnostic systematic review. J Clin Epidemiol. 2009;62(5):558–563. Clinical Question: The systematic review focused on diagnostic accuracy studies to determine if evidence was sufficient to support the use of superior labrum anterior-posterior (SLAP) physical examination tests as valid and reliable. The primary question was whether there was sufficient evidence in the published literature to support the use of SLAP physical examination tests as valid and reliable diagnostic test procedures. Data Sources: Studies published in English were identified through database searches on MEDLINE, EMBASE, and the Cochrane database (1970–2004) using the search term SLAP lesions. The medical subject headings of arthroscopy, shoulder joint, and athletic injuries were combined with test or testing, physical examination, and sensitivity and specificity to locate additional sources. Other sources were identified by rereviewing the reference lists of included studies and review articles. Study Selection: Studies were eligible based on the following criteria: (1) published in English, (2) focused on the physical examination of SLAP lesions, and (3) presented original data. A study was excluded if the article was limited to a clinical description of 1 or more special tests without any research focus to provide clinical accuracy data or if it did not focus on the topic. Data Extraction: The abstracts that were located through the search strategies were reviewed, and potentially relevant abstracts were selected. Strict epidemiologic methods were used to obtain and collate all relevant studies; the authors developed a study questionnaire to record study name, year of publication, study design, sample size, and statistics. Validity of the diagnostic test study was determined by applying the 5 criteria proposed by Calvert et al. If the study met the inclusion and validity criteria, 95% confidence intervals were calculated for each sensitivity, specificity, and positive and negative likelihood ratio reported. No specific information was provided about the procedure if the reviewers disagreed on how the evaluation criteria were applied. Main Results: The specific search criteria led to the identification of 29 full-text articles. The studies were reviewed, and inclusion and exclusion criteria were applied. This resulted in 14 excluded studies and 15 eligible studies for analysis. Of the 15 eligible studies, 1 evaluated only a single physical examination test for a SLAP lesion or biceps tendon injury, and 10 studies evaluated 2 to 6 physical examination tests for a SLAP lesion or biceps tendon injury. Nine studies reported sensitivities and specificities greater than 75%, 4 had sensitivities less than 75%, 3 had specificities less than 75%, 1 did not report sensitivity, and 2 did not report specificities. When validity was assessed for those 15 papers, only 1 study that evaluated the biceps tendon met the 5 critical appraisal criteria of Calvert et al and calculated 95% confidence intervals. When the Speed and Yergason tests were each compared with the gold standard (arthroscopy), the confidence intervals for the positive and negative likelihood ratios spanned 1. This indicated that the test result is unlikely to change the odds of having or not having the condition, respectively. Conclusions: The literature currently used as a reference for teaching in medical schools and continuing education lacks the necessary validity to help rule in or out a SLAP lesion or biceps tendon involvement. Based on the results from the systematic review conducted by Calvert et al, no tests clinically diagnose a SLAP lesion. This is a cause for concern as magnetic resonance imaging or magnetic resonance arthrography, which are frequently used to assess a possible SLAP lesion, may also have diagnostic flaws and may be cost prohibitive. Performing arthroscopy on every patient to rule the condition in or out is unethical, especially if a SLAP lesion is not present. More rigorous validity studies should be conducted for SLAP lesion physical examination tests using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool or Standards for Reporting Diagnostic Accuracy (STARD) criteria.

scholarly journals Glenohumeral Muscle Activation During Provocative Tests Designed to Diagnose Superior Labrum Anterior-Posterior Lesions

2011 ◽  
Vol 39 (12) ◽  
pp. 2670-2678 ◽  
Author(s):  
Vanessa J.C. Wood ◽  
Michelle B. Sabick ◽  
Ron P. Pfeiffer ◽  
Seth M. Kuhlman ◽  
Jason H. Christensen ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Muscle Activation ◽  
Biceps Brachii ◽  
External Rotation ◽  
Slap Lesion ◽  
Radiographic Findings ◽  
Superior Labrum ◽  
Long Head ◽  
Supination External Rotation ◽  
Anterior Posterior

Background: Despite considerable medical advances, arthroscopy remains the only definitive means of superior labrum anterior-posterior (SLAP) lesion diagnosis. Natural shoulder anatomic variants limit the reliability of radiographic findings and clinical evaluations are not consistent. Accurate clinical diagnostic techniques would be advantageous because of the invasiveness, patient risk, and financial cost associated with arthroscopy. Purpose: The purpose of this study was to examine the behavior of the joint-stabilizing muscles in provocative tests for SLAP lesions. Electromyography was used to characterize the muscle behavior, with particular interest in the long head of the biceps brachii (LHBB), as activation of the long head and subsequent tension in the biceps tendon should, based on related research, elicit labral symptoms in SLAP lesion patients. Study Design: Controlled laboratory study. Methods: Volunteers (N = 21) without a history of shoulder injury were recruited. The tests analyzed were active compression, Speed’s, pronated load, biceps load I, biceps load II, resisted supination external rotation, and Yergason’s. Tests were performed with a dynamometer to improve reproducibility. Muscle activity was recorded for the long and short heads of the biceps brachii, anterior deltoid, pectoralis major, latissimus dorsi, infraspinatus, and supraspinatus. Muscle behavior for each test was characterized by peak activation and proportion of muscle activity. Results: Speed’s, active compression palm-up, bicep I, and bicep II produced higher long head activations. Resisted supination external rotation, bicep I, bicep II, and Yergason’s produced a higher LHBB proportion. Conclusion: Biceps load I and biceps load II elicited promising long head behavior (high activation and selectivity). Speed’s and active compression palm up elicited higher activation of the LHBB, and resisted supination and Yergason’s elicited selective LHBB activity. These top performing tests utilize a unique range of test variables that may prove valuable for optimal SLAP test design and performance. Clinical Relevance: This study examines several provocative tests that are frequently used in the clinical setting as a means of evaluating a potential SLAP lesion.

scholarly journals Arthroscopic Treatment of a Type II Superior Labrum Anterior to Posterior (SLAP) Lesion Combined with a Bankart Lesion: Comparative Study between Debridement and Repair of Type II SLAP Lesion by the Status of Lesion

2018 ◽  
Vol 21 (1) ◽  
pp. 37-41
Author(s):  
Sung Hyun Lee ◽  
Min Su Joo ◽  
Kyeong Hoon Lim ◽  
Jeong Woo Kim
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Slap Lesion ◽  
Bankart Lesion ◽  
Visual Analogue Scale Pain ◽  
Type Ii ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Significant Difference

BACKGROUND: The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions.METHODS: Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments.RESULTS: The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021).CONCLUSIONS: In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).

scholarly journals Management of type II superior labrum anterior posterior lesions: a review of the literature

2010 ◽  
Vol 2 (1) ◽  
pp. 6 ◽  
Author(s):  
Xinning Li ◽  
Timothy Lin ◽  
Marcus Jager ◽  
Mark D. Price ◽  
Nicola Deangelis ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Traumatic Event ◽  
Slap Lesion ◽  
Load Test ◽  
Concomitant Treatment ◽  
Type Ii ◽  
Shoulder Pathology ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Anterior Posterior

Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP) lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O’Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25-45), repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years), minimum intervention (debridement, biceps tenodesis/tenotomy) to the type II SLAP lesion results in excellent patient satisfaction and outcomes.

Clinical Assessment of the Dynamic Labral Shear Test for Superior Labrum Anterior and Posterior Lesions

2017 ◽  
Vol 45 (4) ◽  
pp. 775-781 ◽  
Author(s):  
Sonal Sodha ◽  
Uma Srikumaran ◽  
Kyubo Choi ◽  
Amrut U. Borade ◽  
Edward G. McFarland
Keyword(s):  
Predictive Value ◽  
Shear Test ◽  
Case Series ◽  
Slap Lesion ◽  
Likelihood Ratios ◽  
Level Of Evidence ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Diagnostic Arthroscopy ◽  
Lift Off

Background: Diagnosing superior labrum anterior and posterior (SLAP) lesions through physical examination remains challenging. The dynamic labral shear test (DLST) has been shown to have likelihood ratios (LRs) of 31.6 and 1.1 for diagnosing SLAP lesions. Purpose: To determine the clinical utility of the DLST for diagnosing SLAP lesions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: This prospective, consecutive case series included 774 patients who underwent diagnostic arthroscopy and a preoperative DLST between 2007 and 2013. Patients were divided into 3 groups: 610 control patients with no SLAP lesion but with other abnormalities, 9 patients with isolated SLAP lesion (ISL), and 155 patients with concomitant SLAP lesion (CSL), who had a SLAP lesion and another shoulder abnormality. We determined sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), and diagnostic accuracy (DA) of the DLST with and without other tests. Results: The DLST was positive for 242 of 610 controls (40%), 7 of 9 patients (78%) in the ISL group, and 88 of 155 patients (57%) in the CSL group. In the ISL group, the DLST had a sensitivity of 78%, specificity of 51%, PPV of 2%, NPV of 100%, OR of 3.58, and DA of 51%. In comparison, the ORs were 1.09 for the active compression test, 1.30 for the lift-off test, and 1.53 for the relocation test, which were not significantly different from each other. For diagnosing a SLAP lesion existing in a joint with other associated injury, the DLST had a sensitivity of 57%, specificity of 52%, PPV of 23%, NPV of 83%, OR of 1.4, and DA of 53%. Combining all 4 tests did not improve the OR for detecting ISLs or CSLs. Conclusion: The DLST is sensitive but not specific for detecting ISLs. With an OR of 3.58, the DLST is useful for diagnosing ISLs. However, in patients who have CSLs, the DLST is not as useful for diagnosing SLAP lesions.

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