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Superior Labrum Lesions Differential Diagnoses

  • Author: Riley J Williams, III, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Jan 13, 2016
 
 
 
Contributor Information and Disclosures
Author

Riley J Williams, III, MD Associate Professor, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College; Director, HSS Institute for Cartilage Repair

Riley J Williams, III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Society for Sports Medicine, Medical Society of the State of New York

Disclosure: Received royalty from Arthrex Inc for none.

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.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Acknowledgements

Frank A Petrigliano, MD  Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, University of California Los Angeles

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

Disclosure: Nothing to disclose.

References
  1. Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985 Sep-Oct. 13(5):337-41. [Medline].

  2. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990. 6(4):274-9. [Medline].

  3. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995 Jul-Aug. 4(4):243-8. [Medline].

  4. Kim TK, Queale WS, Cosgarea AJ, McFarland EG. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am. 2003 Jan. 85-A(1):66-71. [Medline].

  5. Gaudelli C, Hébert-Davies J, Balg F, Pelet S, Djahangiri A, Godbout V, et al. The Impact of Superior Labral Anterior to Posterior Lesions on Functional Status in Shoulder Instability: A Multicenter Cohort Study. Orthop J Sports Med. 2014 Oct. 2 (10):2325967114554195. [Medline].

  6. Kampa RJ, Clasper J. Incidence of SLAP lesions in a military population. J R Army Med Corps. 2005 Sep. 151(3):171-5. [Medline].

  7. Waterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD. Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Traumatol Arthrosc. 2013 Dec 10. [Medline].

  8. Moseley H, Overgaard B. The anterior capsular mechanism in recurrent anterior dislocation of the shoulder. Morphological and clinical studies with special reference to the glenoid labrum and glenohumeral ligaments. J Bone Joint Surg Br. 1962. 44B:913-27.

  9. Detrisac DA, Johnson LL. Arthroscopic Shoulder Anatomy: Pathological and Surgical Implications. Thorofare, NJ: Slack Inc; 1986.

  10. Bents RT, Skeete KD. The correlation of the Buford complex and SLAP lesions. J Shoulder Elbow Surg. 2005 Nov-Dec. 14(6):565-9. [Medline].

  11. Cooper DE, Arnoczky SP, O'Brien SJ, Warren RF, DiCarlo E, Allen AA. Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am. 1992 Jan. 74(1):46-52. [Medline]. [Full Text].

  12. Prodromos CC, Ferry JA, Schiller AL, Zarins B. Histological studies of the glenoid labrum from fetal life to old age. J Bone Joint Surg Am. 1990 Oct. 72(9):1344-8. [Medline]. [Full Text].

  13. Vangsness CT Jr, Jorgenson SS, Watson T, Johnson DL. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg Br. 1994 Nov. 76(6):951-4. [Medline]. [Full Text].

  14. McGlynn FJ, Caspari RB. Arthroscopic findings in the subluxating shoulder. Clin Orthop Relat Res. 1984 Mar. (183):173-8. [Medline].

  15. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am. 1981 Oct. 63(8):1208-17. [Medline]. [Full Text].

  16. Rodosky MW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med. 1994 Jan-Feb. 22(1):121-30. [Medline].

  17. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, Altchek DW. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation. J Bone Joint Surg Am. 1995 Jul. 77(7):1003-10. [Medline]. [Full Text].

  18. Field LD, Savoie FH 3rd. Arthroscopic suture repair of superior labral detachment lesions of the shoulder. Am J Sports Med. 1993 Nov-Dec. 21(6):783-90; discussion 790. [Medline].

  19. O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998 Sep-Oct. 26(5):610-3. [Medline].

  20. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995 Jun. 11(3):296-300. [Medline].

  21. Kim YS, Kim JM, Ha KY, Choy S, Joo MW, Chung YG. The passive compression test: a new clinical test for superior labral tears of the shoulder. Am J Sports Med. 2007 Sep. 35(9):1489-94. [Medline].

  22. Parentis MA, Mohr KJ, ElAttrache NS. Disorders of the superior labrum: review and treatment guidelines. Clin Orthop Relat Res. 2002 Jul. (400):77-87. [Medline].

  23. Swaringen JC, Mell AG, Langenderfer J, et al. Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions. J Shoulder Elbow Surg. 2006 Sep-Oct. 15(5):576-9. [Medline].

  24. Grossman MG, Tibone JE, McGarry MH, et al. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am. Apr 2005. 87(4):824-31. [Medline].

  25. Fallahi F, Green N, Gadde S, Jeavons L, Armstrong P, Jonker L. Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology. Skeletal Radiol. 2013 Sep. 42(9):1225-33. [Medline]. [Full Text].

  26. Modi CS, Karthikeyan S, Marks A, Saithna A, Smith CD, Rai SB, et al. Accuracy of abduction-external rotation MRA versus standard MRA in the diagnosis of intra-articular shoulder pathology. Orthopedics. 2013 Mar. 36(3):e337-42. [Medline].

  27. Monu JU, Pope TL Jr, Chabon SJ, Vanarthos WJ. MR diagnosis of superior labral anterior posterior (SLAP) injuries of the glenoid labrum: value of routine imaging without intraarticular injection of contrast material. AJR Am J Roentgenol. 1994 Dec. 163(6):1425-9. [Medline]. [Full Text].

  28. Waldt S, Burkart A, Lange P, et al. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol. 2004 May. 182(5):1271-8. [Medline]. [Full Text].

  29. Huang H, Zheng X, Li P, Shen H. Arthroscopic reconstruction of shoulder's labrum with extensive tears. Int J Surg. 2013. 11(9):876-81. [Medline].

  30. Cordasco FA, Steinmann S, Flatow EL, Bigliani LU. Arthroscopic treatment of glenoid labral tears. Am J Sports Med. 1993 May-Jun. 21(3):425-30; discussion 430-1. [Medline].

  31. Yoneda M, Hirooka A, Saito S. Arthroscopic stapling for detached superior glenoid labrum. J Bone Joint Surg Br. 1991 Sep. 73(5):746-50. [Medline]. [Full Text].

  32. Resch H, Golser K, Thöni H, Sperner G. Arthroscopic repair of superior glenoid labral. detachment. J Shoulder Elbow Surg. 1993. 3:147-55.

  33. O'Brien SJ, Allen AA, Coleman SH, Drakos MC. The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy. 2002 Apr. 18(4):372-7. [Medline].

  34. Kim SH, Ha KI, Kim SH, Choi HJ. Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am. Jun 2002. 84-A(6):981-5. [Medline].

  35. Ide J, Maeda S, Takagi K. Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med. 2005 Apr. 33(4):507-14. [Medline].

  36. Silberberg JM, Moya-Angeler J, Martín E, Leyes M, Forriol F. Vertical Versus Horizontal Suture Configuration for the Repair of Isolated Type II SLAP Lesion Through a Single Anterior Portal: A Randomized Controlled Trial. Arthroscopy. 2011 Dec. 27(12):1605-13. [Medline].

  37. Coleman SH, Cohen DB, Drakos MC, et al. Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients. Am J Sports Med. 2007 May. 35(5):749-53. [Medline].

  38. Voos JE, Pearle AD, Mattern CJ, et al. Outcomes of combined arthroscopic rotator cuff and labral repair. Am J Sports Med. 2007 Jul. 35(7):1174-9. [Medline].

  39. Panossian VR, Mihata T, Tibone JE, et al. Biomechanical analysis of isolated type II SLAP lesions and repair. J Shoulder Elbow Surg. 2005 Sep-Oct. 14(5):529-34. [Medline].

  40. Domb BG, Ehteshami JR, Shindle MK, et al. Biomechanical comparison of 3 suture anchor configurations for repair of type II SLAP lesions. Arthroscopy. 2007 Feb. 23(2):135-40. [Medline].

  41. Mileski RA, Snyder SJ. Superior labral lesions in the shoulder: pathoanatomy and surgical management. J Am Acad Orthop Surg. 1998 Mar-Apr. 6(2):121-31. [Medline].

  42. Daluga DJ, Daluga AT. Single-portal SLAP lesion repair. Arthroscopy. 2007 Mar. 23(3):321.e1-4. [Medline].

  43. Selby RM, Altchek DW, Di Giacomo G. The Di Giacomo technique: simplified suture passing in SLAP repair. Arthroscopy. 2007 Apr. 23(4):439.e1-2. [Medline].

  44. Paxinos A, Walton J, Rütten S, Müller M, Murrell GA. Arthroscopic stabilization of superior labral (SLAP) tears with biodegradable tack: outcomes to 2 years. Arthroscopy. 2006 Jun. 22(6):627-34. [Medline].

  45. Garofalo R, Mocci A, Moretti B, et al. Arthroscopic treatment of anterior shoulder instability using knotless suture anchors. Arthroscopy. 2005 Nov. 21(11):1283-9. [Medline].

  46. Beyzadeoglu T, Circi E. Superior Labrum Anterior Posterior Lesions and Associated Injuries: Return to Play in Elite Athletes. Orthop J Sports Med. 2015 Apr. 3 (4):2325967115577359. [Medline].

  47. Bankart A. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg. 1938. 26:23-9.

  48. Bencardino JT, Beltran J, Rosenberg ZS, et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology. 2000 Jan. 214(1):267-71. [Medline]. [Full Text].

  49. Cartland JP, Crues JV 3rd, Stauffer A, Nottage W, Ryu RK. MR imaging in the evaluation of SLAP injuries of the shoulder: findings in 10 patients. AJR Am J Roentgenol. 1992 Oct. 159(4):787-92. [Medline]. [Full Text].

  50. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. 1993 Dec. 161(6):1229-35. [Medline]. [Full Text].

  51. Clemente C. Anatomy: A Regional Atlas of the Human Body. Baltimore, Md: Urban & Schwarzenberg; 1985.

  52. Grauer JD, Paulos LE, Smutz WP. Biceps tendon and superior labral injuries. Arthroscopy. 1992. 8(4):488-97. [Medline].

  53. Higgins LD, Warner JJ. Superior labral lesions: anatomy, pathology, and treatment. Clin Orthop Relat Res. 2001 Sep. (390):73-82. [Medline].

  54. Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995 Jan-Feb. 23(1):93-8. [Medline].

  55. Nam EK, Snyder SJ. The diagnosis and treatment of superior labrum, anterior and posterior (SLAP) lesions. Am J Sports Med. 2003 Sep-Oct. 31(5):798-810. [Medline].

  56. Neer CS 2nd, Welsh RP. The shoulder in sports. Orthop Clin North Am. 1977 Jul. 8(3):583-91. [Medline].

  57. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, Altchek DW. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation. J Bone Joint Surg Am. 1995 Jul. 77(7):1003-10. [Medline]. [Full Text].

  58. Perthes G. Uber operationen bei habitueller schulterluxation. Dtsch z Chir. 1906. 85:199-227.

  59. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am. 1978 Jan. 60(1):1-16. [Medline]. [Full Text].

  60. Smith AM, McCauley TR, Jokl P. SLAP lesions of the glenoid labrum diagnosed with MR imaging. Skeletal Radiol. 1993 Oct. 22(7):507-10. [Medline].

  61. Warner JJ, McMahon PJ. The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am. 1995 Mar. 77(3):366-72. [Medline]. [Full Text].

  62. Warren RF. Lesions of the long head of the biceps tendon. Instr Course Lect. 1985. 34:204-9. [Medline].

  63. Wolf BR, Selby RM, Dunn WR, MacGillivray JD. Lasso repair of SLAP or Bankart lesions: a new arthroscopic technique. Arthroscopy. 2004 Jul. 20 Suppl 2:125-8. [Medline].

  64. Woodburne RT. Essentials of Human Anatomy. 6th ed. New York, NY: Oxford University Press; 1973.

  65. Yian E, Wang C, Millett PJ, Warner JJ. Arthroscopic repair of SLAP lesions with a bioknotless suture anchor. Arthroscopy. 2004 May. 20(5):547-51. [Medline].

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Upper left - Type I superior labrum anterior posterior lesion. Lower right - Type II superior labrum anterior posterior lesion.
Upper left - Type III superior labrum anterior posterior lesion. Lower left - Type IV superior labrum anterior posterior lesion.
Coronal magnetic resonance arthrogram. This image demonstrates detachment of the superior glenoid labrum.
Arthroscopic appearance of a type II superior labrum anterior posterior (SLAP) lesion.
Arthroscopic placement of a suture anchor in the superior glenoid.
Arthroscopic suture placement for superior labrum anterior posterior (SLAP) lesion repair.
Arthroscopic appearance of a superior labrum anterior posterior (SLAP) lesion after repair with a suture anchor.
Simple mattress suture configuration with a single anchor. (Arthroscopy. 2007 Feb;23(2):135-40.)
 
 
 
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