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Superior Labral Lesions Workup

  • Author: S Ashfaq Hasan, MD; Chief Editor: S Ashfaq Hasan, MD  more...
 
Updated: Feb 11, 2016
 

Imaging Studies

On plain radiography of the shoulder, an anteroposterior view of the shoulder in internal and external rotation, outlet, and axillary views should be obtained.[38] Findings are usually normal. Occasionally, a SLAP (superior labrum, anterior and posterior) fracture, which represents a superior humeral head compression fracture, can be observed. Plain radiographs should be carefully reviewed for other potential pathology, such as an os acromiale, an anterior acromial spur, or a degenerative acromioclavicular joint.

Nonenhanced magnetic resonance imaging (MRI) has proved to be unreliable in determining the presence of SLAP tears.[39, 40] It is useful to evaluate potential concomitant pathology, such as partial- or full-thickness rotator cuff tears. It is also valuable in detecting the presence of a paralabral cyst. Ganglion cysts encroaching on the spinoglenoid notch are associated with superior, usually posterior, labral tears.

The use of contrast medium, as in magnetic resonance arthrography, offers improved visualization of intra-articular structures and is thought to improve the ability to accurately detect SLAP tears; however, reported results continue to be highly variable.[41, 42, 43]

Two useful signs on MRI are those of increased signal intensity in the posterior third of the superior labrum and a laterally curved intensity. The sublabral recess does not usually extend to the posterior third of the superior labrum, and therefore, high signal intensity between the labrum and the glenoid in this region is considered to be consistent with a superior labral tear. Another MRI finding considered to be highly suggestive of a superior labral tear is laterally curved signal intensity. On the contrary, a normal sublabral recess results in a medially curved area of signal intensity.

The findings of a retrospective review study conclude that whereas multidetector computed tomography (CT) arthrography showed limitations in the overall percentage of correct classification, it showed high accuracy and interobserver reliability in the diagnosis of SLAP lesions.[44]

 
 
Contributor Information and Disclosures
Author

S Ashfaq Hasan, MD Associate Professor, Chief, Shoulder and Elbow Service, Department of Orthopaedics, University of Maryland School of Medicine

S Ashfaq Hasan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Shoulder and Elbow Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Pekka A Mooar, MD Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

S Ashfaq Hasan, MD Associate Professor, Chief, Shoulder and Elbow Service, Department of Orthopaedics, University of Maryland School of Medicine

S Ashfaq Hasan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Shoulder and Elbow Surgeons

Disclosure: Nothing to disclose.

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Superior labrum anterior and posterior (SLAP) lesion types.
Area of labral detachment is debrided to expose a bony bed. The awl for the anchor is introduced either through the anterosuperior portal or can be introduced percutaneously from a posterolateral portal.
Bioabsorbable anchor double-loaded with nonabsorbable number 2 suture is then implanted
The suture limbs are passed through the labrum. Either a simple or mattress stitch can be utilized. Various suture passing techniques can be used to accomplish this.
In a 1-anchor repair, 1 suture can passed through the labrum posterior to the biceps and the other anterior to the biceps and tied down. Multiple anchors should be used if necessary.
 
 
 
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