SLAP lesions: current controversies

Familiari, Filippo; Huri, Gazi; R, Simonetta; McFarland, Edward G.

doi:10.1302/2058-5241.4.180033

Cited by 19 publications

(14 citation statements)

References 59 publications

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“…Although it is undeniable that MRA maximizes anatomic resolution and diagnostic confidence, the injection of contrast material may provoke several inevitable problems, such as invasion [45], ionizing radiation [46], adverse reactions and additional radiologist time and expertise [47]. Therefore, with regard to the option of MRI vs. MRA for detecting labral pathologic lesions, it seems that patient presentation is an often-neglected but crucial consideration in the choice of imaging tool [48, 49]. Patients with acute symptoms or unstable, severe, pathologic tears are more likely to have intrinsic image contrast in the form of effusion or soft-tissue changes that allow diagnosis and characterization without an invasive procedure [50, 51].…”

Section: Discussionmentioning

confidence: 99%

Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis

Liu

Cheng

Dong

et al. 2019

BMC Musculoskelet Disord

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BackgroundMultiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT.MethodsTwo databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves.ResultsThe retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70–0.84) vs. 0.92 (95% CI 0.84–0.96), a specificity of 0.95 (95% CI 0.85–0.98) vs. 0.98 (95% CI 0.91–0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73–4.83) vs. 6.01 (95% CI 4.30–7.73), respectively.ConclusionMRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.

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Section: Discussionmentioning

confidence: 99%

Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis

Liu

Cheng

Dong

et al. 2019

BMC Musculoskelet Disord

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“…Similar to our findings, there were two cases in the labral repair group that presented with persistent postoperative night pain and three cases developed persistent postoperative stiffness, of which one required a subsequent capsular release. Familiari et al 7 concluded that the treatment of SLAP lesions should fully consider the variable relationship between the labrum tissue and the glenohumeral ligaments, as any errant repair method for these variants may result in a significant impact on the external rotation function of the shoulder. Similarly, McCulloch et al 35 reported that the anterior anchor to the biceps had a great impact on external rotation function; however, one or two anchors posterior to the biceps did not affect the rotation function of glenohumeral joint.…”

Section: Discussionmentioning

confidence: 99%

“…Several theories regarding the etiology of SLAP lesions have been proposed, such as traction injury to the biceps tendon, which can cause inferior subluxation of the humeral head that significantly deteriorates the SLAP lesions, direct compression loads, and repetitive overhead activities caused by internal impingement between the labrum and the undersurface of the rotator cuff when the arm is in abduction and external rotation. This cascade of factors eventually leads to labral failure via the “peel‐back” mechanism 5 , 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Modified Double‐Row Biceps Tenodesis versus Labral Repair for the Treatment of Isolated Type II SLAP Lesions in Non‐Overhead Athletes

Song

Wang

et al. 2022

Orthopaedic Surgery

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Objective: To evaluate the postoperative efficacy and the clinical outcomes of arthroscopic modified double-row biceps tenodesis versus labral repair.Methods: A retrospective study was conducted in 56 patients with isolated type II superior labrum anterior and posterior (SLAP) lesions from March 2015 to November 2018. Thirty patients (male:female = 17:13) were treated with labral repair, and 26 patients (male:female = 15:11) were treated with modified double-row biceps tenodesis. The average age of the labral repair group and the modified double-row biceps tenodesis group were 42.8 AE 10.6 and 40.9 AE 10.2 years, respectively. Pre-and postoperative assessments with the visual analog scale (VAS), University of California Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared between the two treatment groups. Additional outcome measures included patient satisfaction, the time to return to previous activities, workers' compensation status, and postoperative complications.Results: At a 2-year follow-up, the tenodesis group showed significant differences in postoperative VAS (1.5 to 1.8, respectively; p = 0.008), patient satisfaction (92.3% vs. 46.7%, p < 0.001), and recovery time to return to their previous activities (6.8 AE 1.8 vs. 8.1 AE 1.5, p = 0.007) compared to the labral repair group; however, there was no significant difference in postoperative ASES and UCLA scores between the two groups. Additionally, one patient in the tenodesis group developed persistent postoperative stiffness, which was resolved by conservative treatment. In the labral repair group, two patients presented with persistent postoperative night pain, three developed persistent postoperative stiffness, and two required a subsequent capsular release.Conclusions: Compared with the labral repair group, the arthroscopic modified double-row biceps tenodesis showed more encouraging postoperative pain reduction, earlier recovery to previous activities, and higher patient satisfaction.

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“…The labrum in the superior half of the glenoid is typically triangular in shape. About half of the biceps tendon fibers attach to the superior glenoid tubercle while the other half attach to varying degrees to the labrum, anterior and posterior to the superior glenoid tubercle (4).…”

Section: Anatomymentioning

confidence: 99%

Understanding the physical examination of the shoulder: a narrative review

Yang¹,

Kim²,

Kim³

et al. 2021

Ann Palliat Med

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The shoulder joint is a ball and socket joint which provides an extensive range of motion.Shoulder pain and weakness are common complaints among patients, which can lead to disability and affect a person's ability to perform daily activities. Shoulder pain and weakness may be associated with shoulder conditions such as rotator cuff disorders adhesive capsulitis, superior labrum anterior to posterior lesions, lesions in the biceps, acromioclavicular joint disease, or instability. Often, a thorough understanding of the network of bony, ligamentous, muscular, and neurovascular anatomy is required to properly identify and diagnose shoulder pathology. Identifying a specific shoulder pathology may be challenging, considering the numerous structures involved in shoulder function. Appropriate physical examination of the shoulder is important for making an accurate diagnosis and distinguishing certain pathologies of the shoulder.Evaluation of shoulder problem may be reliant upon physical examination, which involves inspection, palpation, assessment of range of motion, strength, and neurovascular integrity. In addition, specific tests are used to reproduce symptoms and signs that would help physicians identify the pathology of the shoulder problem. The aim of this study was to review the shoulder anatomy and describe the specific tests used to evaluate common shoulder conditions to facilitate accurate diagnosis and guide proper treatment of these conditions.

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SLAP lesions: current controversies

Cited by 19 publications

References 59 publications

Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis

Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis

Arthroscopic Modified Double‐Row Biceps Tenodesis versus Labral Repair for the Treatment of Isolated Type II SLAP Lesions in Non‐Overhead Athletes

Understanding the physical examination of the shoulder: a narrative review

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