Superior Labral Lesions Workup

  • Author: S Ashfaq Hasan, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Jul 22, 2011
 

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.[29] 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 AC joint.
  • Nonenhanced MRI has proven to be unreliable in determining the presence of SLAP tears.[30] It is useful to evaluate potential concomitant pathology, such as partial thickness 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.[31, 32, 33, 34]
    • 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 while multidetector computed tomographic arthrography showed limitations in the overall percentage of correct classification, it showed high accuracy and interobserver reliability in the diagnosis of SLAP lesions.[35]
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

S Ashfaq Hasan, MD  Assistant Professor, Director, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Lynn A Crosby, MD, FACS  Chief of Shoulder Division, Professor, Department of Orthopedic Surgery, Wright State University School of Medicine

Lynn A Crosby, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American College of Surgeons, American Fracture Association, American Medical Association, American Medical Tennis Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Arthroscopy Association of North America, Mid-America Orthopaedic Association, and Orthopaedic Research Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

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 through the anterosuperior portal
Bioabsorbable anchor double-loaded with nonabsorbable number 2 suture is then implanted
One limb of each suture is passed through the labrum. 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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