Clinical Presentation and Follow-up of Isolated SLAP Lesions of the Shoulder (SS-04)

Abstract

Introduction There is no definitive clinical sign or symptom which is diagnostic for a superior labral anterior to posterior (SLAP) tear of the shoulder. The purpose of our research is to conduct a retrospective review of isolated SLAP lesions of the shoulder to determine if there are any specific signs, symptoms, or mechanism of injury which are diagnostic for SLAP lesions and the clinical results of operative treatment. Methods In a review of 2,375 shoulder arthroscopies, 140 SLAP lesions were identified, 23 of which had no other intra-articular or subacromial pathology. At the time of diagnostic arthroscopy, there were 19 type II, one type III, two type IV, and one complex type II/III SLAP lesion. There was no other intra-articular or subacromial pathology found including partial or complete rotator cuff tears. Results The mechanism of injury was a fall on an outstretched arm in seven patients, a direct blow to the shoulder in four patients, glenohumeral subluxation or dislocation in two patients, pain while lifting a heavy object in two patients, traction injury in two patients, and an insidious onset in one patient. Five patients experienced an acute onset of pain with overhead sporting activities. The most common complaint was pain and pain with overhead activities in all 23 patients. All patients complained of some sort of painful mechanical-like symptoms in their shoulder which caused pain. The majority of patients mimicked impingement-like symptoms with 12/23 (52%) had a positive Neer test, 8/23(35%) had a positive Hawkins test but all had a normal bursoscopy examination at the time of arthroscopy. All type II SLAP lesions were repaired with a suture anchor technique. The type III and type IV SLAP lesions were debrided. The complex type II and III SLAP lesion was debrided and repaired with a suture anchor technique. Average follow-up was 3.8 years. Using the UCLA shoulder Rating Scale, 17 (74%) had a good or excellent result, 3 (13%) had a fair result, and 2 (8.5%) had a poor result. Conclusion SLAP lesions may mimic impingement, rotator cuff pathology, or anterior instability. The subacromial space should always be evaluated at the time of surgery to make sure there is no evidence of subacromial impingement. In our study, all patients with isolated SLAP lesions had pain and pain with overhead activities and had complaints of painful mechanical-like symptoms in their shoulders but had a normal subacromial space. Treatment with suture anchors gave good or excellent results in 74% of patients.