- Discussion:
- refers to a detachment lesion of the superior aspect of glenoid labrum, which serves as the insertion of long head of
biceps;
- relatively common injury in
throwing atheletes, but may most commonly occur in patients who have fallen or who have received a blow on the shoulder;
- references:
-
Kinetics of baseball pitching with implications about injury mechanisms.
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A Cadaveric Model of the Throwing Shoulder: A Possible Etiology of Superior Labrum Anterior-to-Posterior Lesions.
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Failure of biceps superior labral complex: A cadaveric biomechanical investigation comparing late cocking and early deceleration positions of throwing.
- The role of long head of biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J. Sports Med. Vol 22. 1994. p 121-130.
-
Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation.
-
normal anatomy:
- in 50% of patients, biceps predominately attaches to supraglenoid tubercle where as in other half biceps predominately attaches to superior labrum;
- slight detachment of the superior posterior labrum may be normal in older aults;
-
Buford complex: (see
shoulder capsule)
- anatomical variant: MGHL ligament appears cord-like and will often be frayed and is often associated w/ a physiologic antero-superior sublabral hole;
- glenoid labrum opposite of the MGHL will often be absent;
- attempts to close down this sub-labral hole w/ a absorable tack anchor may precipitate frozen shoulder;
- in most cases a SLAP lesion will show infammatory changes around the biceps tendon origin;
- references:
- Buford complex: "cord like" MGHL and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy 10: p 241-247. 1994.
-
Relationship between the tendon of the long head of biceps brachii and the glenoidal labrum in humans.
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Normal variations of the glenohumeral ligament complex: an anatomic study for arthroscopic bankart repair.
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Anatomical Variants in the Anterosuperior Aspect of the Glenoid Labrum.
-
associated conditions:
-
rotator cuff pathology is present in 40%;
-
anterior instability:
- spinoglenoid cysts
-
Treatment of Labral Tears with Associated Spinoglenoid Cysts without Cyst Decompression
- Radiographic Findings:
- references:
-
Injuries of the superior portion of the glenoid labrum involving the insertion of the biceps tendon: MR imaging findings in nine cases.
-
Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder.
- Clinical Findings:
- pain w/ overhead activity which may mimic
impingement syndrome (see
throwing shoulder)
- mechanicals symptoms;
- ref:
The Resisted Supination External Rotation Test. A New Test for the Diagnosis of Superior Labral Anterior Posterior Lesions.
- Classification and Treatment:
- type I:
- fraying and degeneration of the superior labrum, normal biceps (no detachment);
- most common type of SLAP tear (75% of SLAP tears);
- often associated with
rotator cuff tears;
- these are treated w/ debridement;
- type II:
- detachment of superior labrum and biceps insertion from the supra-glenoid tuberlce;
- when traction is applied to the biceps, the labrum arches away from the glenoid;
- typically the
superior and middle glenohumeral ligaments are unstable;
- may resemble a normal variant (Buford complex);
-
3 subtypes: based on detachment of labrum involved anterior aspect of labrum alone, the posterior aspect alone, or both aspects;
- posterior labram tears may be caused by impingement of cuff against the labrum with the arm in the abducted and externally rotated position;
- as noted by
Tae Kyun Kim et al. type-II lesions in patients older than 40 years of age were associated with a supraspinatus tear where as
in patients younger than 40 years were associated with participation in overhead sports and a Bankart lesion;
- treatment involves anatomic arthroscopic repair;
- references:
-
Biomechanical analysis of isolated type II SLAP lesions and repair.
-
Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears.
-
Ganglion cysts of the shoulder: technique of arthroscopic decompression and fixation of associated type II SLAP lesions.
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Shoulder injuries in overhead athletes. The "dead arm" revisited.
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Differences in Ultimate Strength of the Biceps Anchor and the Generation of Type II SLAP Lesions in a Cadaveric Model.
-
Treatment of Labral Tears with Associated Spinoglenoid Cysts without Cyst Decompression
- type III:
- bucket handle type tear;
- biceps anchor is intact;
- type IV
- vertical tear (bucket-handle tear) of the superior labrum, which extends into biceps (intrasubstance tear);
- may be treated w/ biceps tenodesis if more than 50% of the tendon is involved;
- Arthroscopic Technique: - see:
shoulder arthroscopy:
-
anterior portal
- anterior portal needs to be positioned along superior aspect of the rotator interval anteriorly and slightly superior to the biceps tendon;
- second portal is made just above the subscapularis;
-
anchor position:
- goal is insertion within the superior glenoid tubercle;
- consider hand tamping the drill bit instead of power drilling, so that the drill bit will not skive;
-
arthroscopic knots:
-
Heat Treatment of Arthroscopic Knots and Its Effect on Knot Security
An analysis of 140 injuries to the superior glenoid labrum. SJ Snyder et al J. Shoulder Elbow Surg. July/August 1995. pp 243.
SLAP lesions of the shoulder.
Arthroscopic repair of combined Bankart and superior labral detachment anterior and posterior lesions: a technique and preliminary results.
JJP Warner et al. Arthroscopy Vol 10. p 383. 1994.
Arthroscopic fixation of superior labral lesions using a bioabsorbable implant. a preliminary report. MJ Pagnani et al. Arthroscopy Vol 11. p 194. 1995.
Case report: Arthroscopic repair of a type IV SLAP lesion, the red on white lesion of a component of anterior instability.
SS Burkhart and DL Fox. Arthroscopy. Vol 9. 1993. p 488-492.
Clinical evaluation and treatment of spinoglenoid notch ganglion cysts
Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. Superior labrum anterior posterior.
Arthroscopy Effectively Treats Ganglion Cysts of the Shoulder.
