Imaging Studies

Imaging studies included in the workup are as follows:

Radiographic examination: Routine radiographic examination, including anteroposterior (neutral), axillary, and supraspinatus outlet views of the shoulder joint should be obtained for all patients with suspected shoulder pathology. Although these studies are typically unrevealing, other conditions (eg, glenohumeral arthritis, AC joint arthritis, humeral head migration) may be demonstrated on radiographs. Occasionally, a SLAP fracture or superior humeral head compression fracture may be evident.
Magnetic resonance studies
- MRI is routinely used as part of the initial workup in patients with suspected SLAP lesions; however, if the results of these studies remain inconclusive in the presence of strong historical and physical evidence that suggest labral pathology, magnetic resonance (MR) arthrography is considered.^{[25, 26]}
- Numerous authors have confirmed the utility of gadolinium-enhanced MR arthrography in the detection of labral lesions and injury to the LHB. The sensitivity of this method has been reported to be 82-96%, and the specificity is 91-98%.^{[27, 28]}
- Monu et al suggested that coronal images were the most effective in revealing labral lesions on MRI (as shown below).^[27]MRI findings that suggest damage to the labrum or LHB tendon include the following:
  - High signal intensity at the labrum/anchor interface
  - Increased signal at the superior glenoid fossa
  - Displacement of the superior labrum away from the glenoid surface
  - Presence of a glenoid-labral cyst
    
    Coronal magnetic resonance arthrogram. This image demonstrates detachment of the superior glenoid labrum.
    View Media Gallery
- Although the presence of labral pathology can be delineated via MR arthrography, the precise classification of SLAP lesions utilizing this method remains less reliable.
- Knowledge of normal variants of the anterosuperior labrum, such as a sublabral foramen or Buford complex, is essential because these findings can be misleading in the context of the MRI.

Treatment & Management

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Media Gallery

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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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 Clinical Professor of Orthopaedic Surgery and Sports Medicine, Michigan State University College of Human Medicine; Academic Chief of Orthopaedic Sports Medicine, Regional Director of Ambulatory Clinic Site, Sports Medicine Institute, Detroit Medical Center

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Detroit Academy of Orthopaedic Surgeons, International Association for Dance Medicine and Science, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Michigan Orthopaedic Society, Michigan State Medical Society, Mid-America Orthopaedic Association

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 Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

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.

Superior Labrum Lesions Workup

Imaging Studies

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