Clinical and Imaging Assessment for Superior Labrum Anterior and Posterior Lesions

Abstract

In the evaluation of the painful shoulder, especially in the overhead athlete, diagnosing superior labrum anterior and posterior (SLAP) lesions continues to challenge the clinician because of 1) the lack of specificity of examination tests for SLAP; 2) a paucity of well-controlled studies of those tests; and 3) the presence of coexisting confounding abnormalities. Some evidence indicates that multiple positive tests increase the likelihood that a SLAP lesion is present, but no one physical examination finding conclusively makes that diagnosis. The goals of this article were to review the physical examination techniques for making the diagnosis of SLAP lesions, to evaluate the clinical usefulness of those examinations, and to review the role of magnetic resonance imaging in making the diagnosis.

National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

“…A pain pattern described as posterior-superior or deep within the anterior-superior glenohumeral joint may reflect a SLAP lesion. 18,19 SOR: C 3. Throwing athletes who present with posterior shoulder tightness (loss of .158 horizontal adduction or a glenohumeral internal-rotation deficit [GIRD] of .138 to 158 without a concurrent increase in ER of .158 as compared with the nonthrowing shoulder) should be considered to have an increased risk of shoulder injury, including a SLAP lesion.…”

“…2 This mechanism could also result in other shoulder injuries, such as a rotator cuff tear or anterior instability. 2,18 A chronic SLAP lesion more commonly affects athletes in repetitive overhead sports such as baseball, softball, volleyball, and tennis. 3 Hypothesized mechanisms of injury include tension, torsion, and eccentric loads to the biceps during sport activities that injure the biceps-labral complex.…”

“…25 The patient should be queried regarding the location, quality, and duration of the pain or symptoms. 18 Pain may be generalized to the shoulder, or more likely, be described as a deep shoulder pain located between the acromioclavicular and coracoid processes of the scapula 19 or at the posterior or anterior glenohumeral joint. 18 Pain levels and their effects on activities can vary greatly.…”

“…18 Pain may be generalized to the shoulder, or more likely, be described as a deep shoulder pain located between the acromioclavicular and coracoid processes of the scapula 19 or at the posterior or anterior glenohumeral joint. 18 Pain levels and their effects on activities can vary greatly. Maffet et al 1 noted that among 84 patients diagnosed with a SLAP lesion, 6% reported complete disability, 1% had slight pain, 42% had moderate pain, 10% had marked pain, and 10% had pain only after unusual activities.…”

Posttraumatic persistent shoulder pain: Superior labrum anterior-posterior (SLAP) lesions

“…Although there are tests that are helpful in the diagnosis, physical examination and history are not useful for definitive diagnose of a SLAP lesion. Reports in the literature describe at least 26 maneuvers as useful in helping to make the diagnosis of a SLAP lesion [5,6] Cook et al [7] reported that the strongest positive predictive value and negative predictive value of the these tests were provided by the Kim Test II and the Labral Tension test.…”