Diagnosis and Management of Superior Labral Anterior Posterior Tears in Throwing Athletes

Abstract

Injury to the superior glenoid labrum is increasingly recognized as a significant source of shoulder pain and dysfunction in the throwing athlete. Several theories have been proposed to explain the pathogenesis of superior labral anterior posterior (SLAP) tears. The clinical examination of the superior labrum-biceps tendon complex remains challenging because of a high association of other shoulder injuries in overhead athletes. Many physical examination findings have high sensitivity and low specificity. Advances in soft tissue imaging such as magnetic resonance arthrography allow for improved detection of labrum and biceps tendon lesions, although correlation with history and physical examination is critical to identify symptomatic lesions. Proper treatment of throwers with SLAP tears requires a thorough understanding of the altered biomechanics and the indications for nonoperative management and arthroscopic treatment of these lesions.

Return to Play of Elite Overhead Athletes with Superior Labral Anterior Posterior Tears only after Rehabilitation

“…The goals of rehabilitation include improving posterior capsular flexibility as well as strengthening the rotator cuff and scapular stabilizer muscles. 5,7,11,33) However, limited data and mid-term follow-up remain to be the weaknesses of the current preliminary study, warranting more research in this field. Large multicenter prospective trials will be necessary to clarify this problem for orthopedists to best guide treatment for elite overhead athletes with SLAP lesions.…”

“…Advances in diagnostic imaging and arthroscopic surgical techniques have improved our ability to identify and successfully treat SLAP lesions. 3,7,11) Multiple reports have documented successful outcomes using surgical treatment of SLAP lesions. 4,5,9,10,[13][14][15] Although literature review revealed that SLAP repair provides biomechanical stability with excellent clinical results, there was still controversy regarding the outcomes of overhead athletes being able to return to their pre-injury level of play.…”

“…5,9,10) Moreover, the surgical treatments of these various types of SLAP lesions differ from each other in terms of the fixation methods and operative devices, such as staples, metallic and absorbable suture anchors or tacks. 5,11,12) To date, there have been multiple reports documenting successful outcomes using surgical treatment for SLAP lesions. 4,5,9,10,[13][14][15] Although literature review revealed that SLAP repair provides biomechanical stability and achieves excellent clinical results, the outcomes in the ability of these overhead ath-letes to be able to return to pre-injury level of play remains controversial.…”

SLAP Lesions Part III: Return to Play After SLAP Repair

“…Patients with SLAP lesions present challenges to diagnose given frequent nonspecifi c history and physical exam fi ndings [ 4 ]. Patients who are ultimately diagnosed with arthroscopically proven SLAP lesions typically present with pain during overhead activities and mechanical symptoms of catching, locking, popping, or grinding [ 3 , 13 , 14 ].…”

“…The common nomenclature, superior labral anteriorposterior or "SLAP" tear, was described by Synder et al [ 3 ] in 1990. The true incidence of SLAP lesion may be diffi cult to discern, however; numbers have ranged from 6 to 26 % according to a recent review of the literature [ 4 ]. A certain subset of patients may benefi t from surgical repair of SLAP tears.…”