In athletic patients under the age of 20 years, the recurrence rates are greater than 90%. It also discusses incidence, classification, injury mechanisms, subjective and physical examination find. Slap lesion is mostly combined with a lesion of the proximal head of the biceps because it attaches on the superior part of the labrum glenoidalis. Making appropriate diagnostic judgements regarding slap lesions is particularly pertinent given the gold standard of management. Superior labrum anterior to posterior slap lesions are an abnormality of the superior glenoid labrum and are a significant cause of shoulder pain and instability. Impingement syndrome shoulder georgia rotator cuff tear. Your shoulder is a ballandsocket joint made up of three bones. The model simulates the abducted, externally rotated position of the glenohumeral. The shoulder is the bodys most mobile joint, which makes it susceptible to dislocation. Many, many, many people have labral tears simply as a result of aging and use. Slap lesions were not recognized until the 1980s when keyhole surgery of the shoulder was starting to be performed. Dec 22, 2011 slap lesions are very much overdiagnosed and overtreated. If you have pain at rest or at night, or pain with simple motions and stiffness, your pain is most likely not caused by a slap lesion.
Associated tear of the anterior inferior labrum bankart lesion with superior extension of the tear is seen and considered as slap v lesion. The most useful radiographic viewsincludethewestpointview,didi. It stands for superior labral anterior to posterior tear, meaning a tear of the upper rim of the labrum from front to back. To make squares disappear and save space for other squares you have to assemble english words left, right, up, down from the falling squares. Some slap lesions can be simply debrided and cleaned, whilst most need repairing depending on the severity of the lesion. The shoulder labrum is a ring of cartilage around the shoulder socket that stabilizes the head of the upper arm bone.
Snyder and coworkers described a superior glenoid labral lesion that begins posteriorly and ends anteriorly, and coined the term slap. Coronal mri image of the shoulder showing extravasation. Many conditions affecting the shoulder can be treated nonsurgically. Slap lesion of the shoulder joint cooper university.
A scope and surgical instrument are inserted into the joint. Art at the reading shoulder and elbow centre original fine art prints all dealing with human body in different situations by four artists are exhibited in the reading shoulder and elbow. Despite direct mr techniques being considered the standard of reference for diagnosis of labral lesions, computed tomographic ct arthrography also has a reported accuracy of 86. The upper superior part of the labrum anchors one of the two tendons of the biceps muscle.
Slap lesion of the shoulder joint cooper university health care. Watch video the term slap tear refers to a tear of the superior labrum of the shoulder. The label of slap, an abbreviation for superior labrum anterior and posterior, was coined by snyder et. Lesions of the biceps pulley as cause of anterosuperior. The study of other shoulder lesions, unspecified shoulder has been mentioned in research publications which can be found using our bioinformatics tool below. Listen to the bbc radio4 programme a day in the operating theatre at the reading shoulder unit at the royal berkshire hospital case notes with dr mark porter on regional anaesthesia for shoulder surgery. Dislocation of the shoulder joint occurs in 1 to 2% of the populatio. It is a triangular anatomic area in the an terosuperior aspect of the shoulder, which is.
It reduced spontaneously and again later during the same match. Mr imaging of slap lesions open orthopaedics journal. Pdf diagnosis of lesions of the shoulder joint using. Repair of superior labrum anterior posterior lesions has become one of the main. Shoulder impingement is also called as swimmers shoulder, tennis shoulder, or rotator cuff tendinitis. There are four different types of slap lesions, this is a type iii.
There many different variations of slap tears, which have different levels of severity and treatment strategies. Apart from its use in patients with mr imaging contraindications, ct arthrography may also be used to evaluate the osseous structures. The glenoid labrum is the fibrocartilage of the shoulder joint, anchoring the joint capsule and shoulder ligaments. Injury occurs from inferior traction on the shoulder, as well as excessive tension on and twisting of the long head of biceps tendon lhb at its insertion along the superior labrum that occurs during the cocking motion of throwing 2, 3.
Hillsachs lesions were more prevalent among patients with shorter duration of symptoms. Slap lesions of the shoulder are challenging to diagnose by clinical means alone. Choosing a search strategy and utilizing it consistently is a helpful method to overcome common errors seen in diagnostic radiology. Slap lesions are becoming a more recognized cause of shoulder pain and disability. Normal anatomy and associated lesions at mr arthrography. This makes the shoulder joint have a large range of motion and explains why we. Our laboratory has developed a biomechanical model of the human shoulder which was used to determine the effects of creating a bankart lesion on cadaveric specimens and then to compare the effects of two repair techniques. Before the use of shoulder arthroscopy and magnetic resonance imaging mri in the diagnosis and management of shoulder problems, glenoid labrum lesions were underappreciated. The case demonstrates the superiority of the mr arthrography in detection of slap lesions. Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been discussed, defined, and investigated since andrews et al1 first described this.
Lettris is a curious tetrisclone game where all the bricks have the same square shape but different content. The small size of the structures requires high spatial resolution. Slap stands for superior labrum anterior and posterior, which defines the anatomical location of the injured area. Superior labrum anterior posterior slap tears uptodate. The pulley complex is composed of the superior glenohumeral liga ment, the coracohumeral. Radiological assessment of shoulder instability open access. The most common associated injury was a hillsachs lesion, followed by slap tears. Ninety percent of shoulder dislocations are anterior, and traumatic injuries account for 95% of them4, 5, 6, 7. Conservative management is ineffective for this lesion and therefore it is integral for the sports physiotherapist to successfully diagnose and refer appropriately. Shoulder radiograph an approach radiology reference. A slap lesion is a tear of the labrum or cartilage disc that encircles the socket of the shoulder. A dislocated shoulder is an indication of an injury where the upper arm bone pops out of the cupshaped socket of the shoulder blade.
Imaging the glenoid labrum and labral tears radiographics. The order in which you interpret the radiograph is personal preference. Full text pdf 3897k abstracts references16 the laxity of shoulder is one of main factors affecting shoulder lesions in athletes. A provider should be able differentiate an incidental, preexisting finding from an acute injury causing a tear or other pathology.
Slap lesions, tears of the superior glenoid labrum that extend anteriorly to posteriorly, 5,6 have been described in throwing athletes and gymnasts, but to our knowledge this is an undocumented injury in rock climbers. Alpsa, slap2 tear, and gagl lesion of shoulder radiology. The term slap stands for superior labral tear anterior to posterior. The labrum is a piece of fibrous tissue made of cartilage, called fibrocartilage, which surrounds the glenoid or the socket of the. Shoulder radiographs are common films to see in the emergency department, especially during the weekend after sporting events. Many slap lesions occur in throwing or overhead athletes. The associated lesions are also treated such as labrum and ligament lesions with instability. The journal of arthroscopic and related surgery 64. Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete. The shoulder joint is a ball and socket joint, similar to the hip. The laxity of shoulder is one of main factors affecting shoulder lesions in athletes.
Imaging imaging the components of the rotator interval poses several challenges. While bankart 1 is given credit for describing injury to the anteriorinferior glenoid labrum in 1938, the first description of injuries to the superior glenoid labrum in throwing athletes was in 1985 by andrews et al. This is a very common diagnosis for shoulder injuries. Bankart tear tear of the anteroinferior glenoid labrum. The instrument will be used to reattach the labrum to the glenoid using suture and anchorlike devices. A slap tear is an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint. It is the most dislocated joint of the body and it moves in several directions and most dislocations occur. The labrum is the cuff of cartilage that extends the socket part of the shoulder blade to better accept the ball end of the arm bone. Whether acute from an injury or chronic due to longterm overuse, shoulder pain can be very debilitating. It extends along the tendon formed by the merger of the coracobrachialis tendon and the short head of the biceps tendon. Variational anatomy and degenerative lesions of the shoulder joint. More specifically, superior labrum lesions about the insertion of the long biceps tendon were typically noted or managed using standard open surgical techniques.
These combine labral lesion and lesion of the proximal insertion of the long head of the biceps brachii tendon. Buckethandle tear of the anterior superior glenoid labrum associated with bicipital tendinosis. If slap lesion appears on your list of differential diagnoses then few clinical tests will effectively improve your posttest odds. It forms a rim like structure which aids in stabilizing the shoulder joint and provides an attachment for the ligaments of the shoulder. The relative size of these two structures is analogous to a golf ball head of the humerus on a golf tee glenoid. Impingement syndrome shoulder georgia rotator cuff tear georgia. Sep 15, 2010 this study identifies the importance of diagnostic accuracy during the objective examination of the athlete with a shoulder injury. These injuries can usually be diagnosed on an mrarthrogram or ctarthrogram. It is the condition of inflammation of the tendons of the shoulder joint caused by motor vehicle accidents, trauma, and while playing sports such.
Superior labral anteroposterior lesions of the shoulder. A slap tear is a torn piece of cartilage in the inner portion of the shoulder joint. Structure, function, and physical therapy diagnosis and treatment abstract. Slap tears are routinely diagnosed using magnetic resonance imaging mri. The labrum is a piece of fibrous tissue made of cartilage, called fibrocartilage, which surrounds the glenoid or the socket of the shoulder. Shoulder instability and dislocation occur when the shoulder capsule is stretched or torn, andor when the labrum is detached from the glenoid. Slap lesion repair emily cotey, emily hurysz, and patrick schroeder abstract slap lesion, which stands for superior labrum anterior and posterior, is a detachment tear of the superior labrum that originates posteriorly to the tendon of the long head of the biceps and extends anteriorly. A slap tear is when there is damage to the ring of cartilage on the socket of the shoulder joint, known as the labrum. In the superior labrum, slap lesions are the most frequent. A bankart lesion is the most common injury sustained with traumatic dislocation, but other injuries can occur. It was not possible to affirm that, in patients with chronic instability of the shoulder, the numbers of associated lesions increased with the duration of symptoms or with the number of episodes of dislocation. Browse our catalog of research reagents for other shoulder lesions, unspecified shoulder including. Slap v lesion mr arthrography of the shoulder radiology.
Slaplabral lesion shoulder anatomy the shoulder joint is formed by the humerus upper arm and the glenoid labrum of scapula shoulder blade. Medstar washington hospital center has a team of orthopaedic specialists dedicated to helping you regain the functionality of your shoulder and perform a full range of motion. Hagl lesion of the shoulder a 24 year old rugby player presented to an orthopaedic surgeon with a history of dislocation of the left shoulder. Slap tear shoulder injury and treatment sportshealth. Superior labrum anterior to posterior slap lesions of.
Prevalence of shoulder labral injury in collegiate football players. More commonly, though, a tear occurs as a result of chronic repetitive stress associated with an overhead sport such as pitching. Another mechanism of injury to the glenoid labrum is characterized by an internal impingement syndrome, in which lesions rekeywords. Diagnostic utility of clinical tests for slap lesions. It can be painful andor limit movement in the shoulder, especially overhead motions. Associated tear of the anterior inferior labrum bankart lesion with superior extension of. Dec 08, 2015 rotator cuff lesions had the lowest prevalence.
If the arm is forcefully bent inward and twists at the shoulder, the humeral head acts as a lever and tears. The feature that makes slap possible is the way the upper biceps tendon hooks over the head of the humerus. Superior labrum anterior to posterior slap lesions of the. Anterior shoulder instability with or without a slap lesion clinics in orthopedic surgery vol. When the labrum of the shoulder joint is torn, the stability of the shoulder joint may be compromised. These lesions have come into public awareness because of their frequency in athletes involved in overhead and throwing activities in turn relating to relatively recent description of labral injuries in throwing athletes, 4 and initial definitions. On examination there was no residual instability, but the apprehension test for anterior instability was positive. The measurement of the anteriorposterior laxity was done with. The diagnosis of these lesions is difficult due to vague symptoms and high degree of. Given the complexity of the shoulder anatomy, the normal variations seen across the population, associated injury patterns, and poor interobserver reliability in the classification of slap tears, the use of an algorithm has been suggested in order to systematically define slap lesions of the shoulder.
The disabled throwing shoulder marianjoy medical library. A shoulder mri performed in a patient with a minor injury will likely show an incidental abnormality. A slap tear or lesion occurs when there is damage to the. Thewestpointview,avariationoftheaxillarylateral radiograph, is a tangential viewof the anteroinferior aspect of the glenoid and is the best view for radiographicdetection of osseous bankart lesions5 fig. The glenoid labrum is most commonly injured by a fall or from repetitive overhead movements, such. A slap tear is an injury to a part of the shoulder joint called the labrum.
A tear can occur as a result of a single traumatic event. Lesioni della puleggia bicipitale come causa di impingement anterosuperiore di spalla nello sportivo. This motion performed while the hand carries a weight places stress on the labrum. A large hillsachs deformity of posterosuperior humeral head and a denuded torn anteroinferior labrum 26 oclock position with a redundant glenolabral pouch consistent with alpsa lesion a nonosseous bankart variant. A slap tear is an injury to the superior part of the labrum in the shoulder.
A specific pattern of injury to the superior labrum of the shoulder was identified. Tears of the superior labrum near to the origin of the long head of biceps were first described among throwing athletes by andrews in 1985. You can find out more in the bankart lesion and rotator cuff tear sections. When throwing a ball or other object, or performing similar motions eg, swinging a hammer, the shoulder is forcefully abducted and externally rotated during the cocking phase. Park s, loebenberg mi, rokito as, zuckerman the shoulder in baseball pitching. To measure the anteriorposterior laxity of shoulder, a stress machine was arranged because the ordinary rentogenographic measurement is not suitable. Fall onto an outstretched hand repetitive overhead. Anatomy your shoulder is a ballandsocket joint made up of three bones. Surgical interventions for type ii superior labrum anterior posterior. Slap tears can also be associated with a bankart lesion, where there is damage to the bottom part of the glenoid labrum, or a rotator cuff tear, damage to the shoulder muscles. Snyder sj1, karzel rp, del pizzo w, ferkel rd, friedman mj. Prevention strong shoulder muscles remain the best defence against shoulder injuries. The yergasons test slap lesion biceps pathology the yergasons test slap lesion biceps pathology biceps load ii test. The bankart lesion of the shoulder has long been associated with anterior instability.
A slap tear or lesion occurs when there is damage to the superior uppermost area of the labrum. Slap lesion repair emily cotey, emily hurysz, and patrick. This article describes the structure and function of the labralbicipital complex. Huijbregts, pt, dpt, ocs, faaompt, fcamt2, richard jensen, pt, phd3 s uperior labrum anteriortoposterior slap lesions have been dis. It is the condition of inflammation of the tendons of the shoulder joint caused by motor vehicle accidents, trauma, and while playing sports such as tennis, baseball, swimming and weight lifting. A slap tear or slap lesion is an injury to the glenoid labrum fibrocartilaginous rim attached around the margin of the glenoid cavity. The head of your upper arm bone fits into a rounded socket in your shoulder blade.
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