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Abstract & Commentary
Synopsis: An update of current diagnosis, evaluation, and treatment of SLAP lesions (superior labral tears) is presented. This is a thorough review of the literature and current clinical practice.
Source: Musgrave DS, Rodosky MW. Am J Orthop. 2001;30(1):29-38.
Musgrave and rodosky introduce this review article with a historical review of labral lesions in the shoulder. Labral anatomy and biomechanics are also discussed. The diagnosis, physical exam, and specific tests are then presented. The history usually involves a clicking or popping in the shoulder, especially with overhead activities. There also may be a history of instability or biceps-related anterior shoulder pain. Several physical exam tests such as the O’Brien and Kibler tests are discussed, as well as biceps tendon tests. The Snyder test was omitted, but it can be equally helpful. Musgrave and Rodosky stress the importance of diagnosing concomitant injuries such as rotator cuff tears, instability, cartilage injuries, and impingement lesions such as acromioclavicular joint arthritis and acromial spurring. Plain radiographs, CT arthrogram, MRI, and MRI with a gadolinium arthrogram can all be helpful diagnostically, but arthroscopy is the gold standard for diagnosis. Treatment of the labral tear usually requires surgical debridement or fixation. Concomitant pathology should also be addressed at the time of surgery. Types I through VII SLAP lesions are all specifically discussed. The type of SLAP lesion, concomitant injuries, and the patient’s symptoms dictates treatment.
COMMENT BY STEPHEN B. GUNTHER, MD
This article reviews the anatomy and biomechanics of the glenoid labrum and briefly mentions other labral lesions. There is a thorough discussion of history, physical examination, and imaging of SLAP lesions. This is an important discussion since the diagnosis of SLAP lesions can be difficult. Most of these lesions were treated with "benign neglect" in the past, but shoulder arthroscopy has introduced a new avenue for diagnosis and treatment of these lesions.
An educated physician is the best tool for diagnosing SLAP lesions. MRI enhanced with a gadolinium arthrogram is also helpful. Musgrave and Rodosky also present previous work describing anatomical labral variants. This is important to remember so that normal labral variants are not treated with debridement or repair. Surgical treatment depends on the type of SLAP lesion and other associated pathology as well as patient age, activity level, and degree of symptoms. Surgical fixation has progressed from large, absorbable tacks to smaller absorbable devices and suture anchors. Surgical outcomes have been very successful in short-term follow-up studies.