Current Concepts in the Recognition and Treatment of Superior Labral (SLAP) Lesions

Abstract

Pathology of the superior aspect of the glenoid labrum (SLAP lesion) poses a significant challenge to the rehabilitation specialist due to the complex nature and wide variety of etiological factors associated with these lesions. A thorough clinical evaluation and proper identification of the extent of labral injury is important to determine the most appropriate nonoperative and/or surgical management. Postoperative rehabilitation is based on the specific surgical procedure as well as the extent, location, and mechanism of labral pathology and associated lesions. Emphasis is placed on protecting the healing labrum, while gradually restoring range of motion, strength, and dynamic stability of the glenohumeral joint. The purpose of this paper is to provide an overview of the anatomy and pathomechanics of SLAP lesions and review specific clinical examination techniques used to identify these lesions, including 3 newly described tests. Furthermore, a review of the current surgical management and postoperative rehabilitation guidelines is provided. J Orthop Sports Phys Ther 2005;35:273-291.

Progression of function and pain relief as indicators for returning to sports after arthroscopic isolated type II SLAP repair—a prospective study

“…Recommendations as to the right time point for a return to sports vary in the literature, ranging from 5 to 12 months after SLAP repair [8–10, 14, 25–28]. Others advocate full ROM, minimal pain, adequate strength and dynamic stability, and an appropriate rehabilitation progression [29] as indicators signalling the ability to return to preoperative sports activities.…”

Glenohumeral Muscle Activation During Provocative Tests Designed to Diagnose Superior Labrum Anterior-Posterior Lesions

“…In this study the orientation of the arm remained similar to the original definition, but Speed's test was performed dynamically mimicking a variation of the original test which is commonly referred to as the “dynamic Speed's test”. 31 The subject's arm started hanging beside and parallel to the body, and then the subject was asked to raise the arm (flex the shoulder) with as much force as possible to 90°. Regardless of the force applied by the subject, motion was restricted to a constant velocity by the Biodex System of 60° per second.…”

“…The patient is then asked to perform an isometric contraction of the Biceps 31 . The Pronated Load Test was negligibly modified for this study.…”

“…In most cases, the evaluation of the physical exams by the original authors reveals promising accuracy for the detection of SLAP lesions 2, 17, 18, 22, 23, 32 . However, secondary studies often fail to reproduce the initial findings, typically reporting much lower values for the sensitivity and specificity of the physical examination tests 8, 11, 14, 20, 24, 25, 31 . The discrepancies between the findings most likely reflect two primary difficulties: 1) the clinical detection of SLAP lesions is hindered by the fact that SLAP lesions are rarely isolated; meaning they are frequently accompanied by other various glenohumeral pathologies which are potential sources for labral symptoms 3 , and 2) differences in study protocols and problems associated with the methods used to verify accuracy of the physical examinations make comparisons between studies difficult 8 .…”

Outcomes in patients with glenoid labral lesions: a cohort study

“…The labrum is a fibrocartilaginous ring that attaches to the bony rim of the glenoid fossa, 1 doubling the depth of the glenoid fossa to help provide stability. 2 The superior labrum attaches to the superior glenoid by loose connective fibres and provides attachment for the long head of the biceps tendon, forming the biceps anchor.…”