Labrum Anterior Posterior Lesions Research Articles

Superior labral anterior-posterior (SLAP) tears: recent advances and outcomes

Purpose of review The study presents a concise review of the published literature of disorders of the superior labrum, with a focus on reports published within the past 2 years. The aim of this review is to assist physicians with their assessment and treatment of lesions of the superior labrum. Recent findings The superior labrobicipital complex has many anatomical variations, some of which may be confused with superior labral anterior-posterior lesions. Various theories exist for potential mechanisms of injury to the superior labrum. Progress has been made into understanding the aspects involved in making a clinical diagnosis of a superior labral anterior-posterior lesion, with the physician's appreciation of the overall patient profile seemingly more important than any specific physical test. Imaging of the superior labrum continues to evolve. Research into the interobserver reliability of the arthroscopic diagnosis of a superior labral anterior-posterior lesion has demonstrated a poor level of agreement between clinicians. Surgical techniques for the treatment of superior labral anterior-posterior lesions and supraglenoid cysts continue to evolve. Summary Recent research has provided insights into understanding disorders of the labrobicipital complex. A clearer understanding of issues including normal age-related anatomy and function of the superior labrobicipital complex will aid in the diagnosis and treatment of superior labral anterior-posterior lesions.

Incidence of Associated Injuries with Acute Acromioclavicular Joint Dislocations Types III through V

Background Traumatic acromioclavicular (AC) joint dislocations are common injuries among the active population. The injury mechanism requires excessive force delivered by a fall or blow to the shoulder. Associated injuries may occur and remain undetected if they are masked by the painful and prominent AC joint injury. Hypothesis Intra-articular injuries associated with high-grade AC joint dislocations are common. Study Design Case series; Level of evidence, 4. Methods Between 2002 and 2007, 77 patients (68 male, 9 female; average age, 35.5 years; range, 17-62 years) were surgically treated for acute AC joint dislocations (Rockwood type III, 5; type IV, 30; and type V, 42). All patients underwent diagnostic glenohumeral joint arthroscopy. Concomitant intra-articular injuries were identified and treated. Results Intra-articular injuries were found in 14 of 77 patients (18.2%). Superior labral anterior posterior (SLAP) lesions were observed in 11 of 77 patients 14.3% (SLAP I, 3; II, 2; III, 3; and IV, 3). Nineteen percent of Rockwood V lesions had associated SLAP lesions (SLAP I excluded), whereas only 3.4% of Rockwood IV lesions showed SLAP lesions. A complete supraspinatus tear was detected in 1 case, and partial articular-sided supraspinatus tears were detected in 2 cases. Four patients sustained an accompanying fracture. Conclusion Concomitant injuries to the shoulder girdle obtained during traumatic AC joint separation may be more frequent than previously thought. Clinical diagnosis may be difficult in the setting of an acute and painful dislocated AC joint. Shoulder arthroscopy during arthroscopic AC joint stabilization may aid in detecting associated injuries.

Biomechanical Assessment of TYPE II Superior Labral Anterior-Posterior (SLAP) Lesions Associated with Anterior Shoulder Capsular Laxity as Seen in Throwers

Background Type II superior labral anterior-posterior lesions in throwers are often associated with anterior shoulder capsular laxity. Hypothesis Shoulder instability in patients with type II superior labral anterior-posterior lesions may result from the associated shoulder capsular laxity rather than the superior labral anterior-posterior lesion alone. Study Design Controlled laboratory study. Methods Six cadaveric shoulders were externally rotated to 20% beyond the maximum humeral external rotation at 60° of glenohumeral abduction, which simulated 90° of shoulder abduction, to detach the superior labrum and elongate the anterior shoulder capsular ligaments. The detached labrum was then repaired to isolate the effect of the detached superior labrum and that of the capsular laxity. Rotational range of motion was measured at 60° of glenohumeral abduction. Anterior-posterior glenohumeral translation was measured at 30° and 60° of glenohumeral abduction. Superior-inferior glenohumeral translation was measured at 0° and 60° of glenohumeral abduction. Results The experimentally created type II superior labral anterior-posterior lesion and capsular laxity significantly increased anterior translation at 30° (mean difference, 1.0 ± 0.8 mm; P < .05) and 60° (mean difference, 2.2 ± 2.0 mm; P < .05) of glenohumeral abduction. Subsequent superior labral anterior-posterior repair restored the anterior translation but only at 30° of glenohumeral abduction (mean difference, 0.9 ± 0.6 mm; P < .05). Conclusion Because of the anterior capsular laxity associated with type II superior labral anterior-posterior lesions, superior labral anterior-posterior repair of the peeled-back superior labrum may not restore anterior glenohumeral translation at 90° of shoulder abduction. Clinical Relevance Anterior shoulder capsular laxity associated with type II superior labral anterior-posterior lesions may cause anterior shoulder instability at 90° of shoulder abduction in throwers even after superior labral anterior-posterior lesion repair.

Analysis of Interobserver and Intraobserver Variability in the Diagnosis and Treatment of SLAP Tears Using the Snyder Classification

Background Superior labral anterior posterior lesions are a relatively rare entity, and classification as a basis for selection of treatment has remained a point of controversy. Hypothesis There will be substantial interobserver and intraobserver variability in the diagnosis and treatment of superior labral anterior posterior tears by experienced arthroscopic specialists. Study Design Cohort study (diagnosis), Level of evidence, 2. Methods Compact discs containing 22 video vignettes of approximately 15 seconds duration were sent to the membership of the Arthroscopy Association of North America, American Shoulder and Elbow Society, and AOSSM. Each surgeon was asked to review the vignettes, classify the superior labral anterior posterior lesion type, and provide a treatment recommendation for each vignette. Seventy-three expert surgeons responded to the solicitation with a completed analysis. The same CD-ROM was re-sent to each of these 73 surgeons at a minimum of 12 months after the first viewing to obtain data on intraobserver reliability. Seventeen of the 73 surgeons returned this second CD-ROM with a complete analysis. Demographic data were also obtained from each surgeon. Multivariable logistic regression analysis was used to analyze the data, and 95% confidence intervals were established for each superior labral anterior posterior type (I-IV) with regard to diagnosis and treatment decision. Results The 22 vignettes analyzed by 73 surgeons resulted in 1606 responses. Several significant trends were noticed with regard to diagnosis and treatment from the responses: (1) surgeons had difficulty distinguishing type III lesions from type IV lesions, (2) the treatment of type III lesions is much more variable than that of any other subtype, and (3) surgeons had difficulty distinguishing normal shoulders from type II superior labral anterior posterior tears. No relationship was identified between correct treatment decisions based on diagnosis and any of the demographic factors analyzed. Our analysis of intraobserver variability showed only moderate agreement. The analysis of interobserver variability improved significantly when the diagnoses were analyzed based on treatment decision. Conclusions There is substantial interobserver and intraobserver variability among experienced shoulder arthroscopic specialists with regard to diagnosis and treatment of superior labral anterior posterior tears. Intraobserver agreement using the Snyder classification indicated only moderate agreement. Analysis of interobserver agreement based on treatment decisions results in superior concordance among experienced surgeons for the diagnosis of superior labral anterior posterior lesions.

Classification of Anterosuperior Glenoid Labrum Variants and Their Association With Shoulder Pathology

This prospective study of 367 consecutive shoulder arthroscopies assessed variants of the anterosuperior glenoid labrum and associated shoulder pathology. Thirty-three shoulders were excluded because of prior surgery, septic arthritis, or adhesive capsulitis. Anterosuperior glenoid variants were classified as: type I, cordlike middle glenohumeral ligament without sublabral foramen; type II, sublabral foramen without a cordlike middle glenohumeral ligament; type III, sublabral foramen with a cordlike middle glenohumeral ligament; and type IV, absent anterosuperior labrum with the anterior aspect of the superior labrum continuous with a cordlike middle glenohumeral ligament. The presence of these variants was correlated with the incidence of shoulder pathology found on arthroscopic inspection. Of 334 shoulders, 118 (35.3%) had variants of the anterosuperior glenoid labrum. Of these, 32 (27.1%) were type I, 27 (22.9%) were type II, 34 (28.8%) were type III, and 25 (21.2%) were type IV. The incidence of advanced superior labrum anterior-posterior lesions in the 86 shoulders displaying a type II, III, or IV variant was significantly higher than in shoulders with no anterosuperior variant (48.8% versus 23.6%, P<.001). Other pathologic findings were not significantly increased in shoulders with variants compared to those without. Level 1.

Diagnostic Accuracy of Clinical Tests for Superior Labral Anterior Posterior Lesions: A Systematic Review

Systematic literature review. To conduct a systematic review of case series and clinical trials that investigate the diagnostic accuracy of clinical tests for superior labral anterior posterior (SLAP) lesions. Primary contact practitioners are often presented with shoulder problems and use a battery of clinical tests to reach a diagnosis. Early detection of SLAP pathology may lead to more optimal interventions and better outcomes for patients. The OVID search interface was utilized with MEDLINE, AHMED, CINAHL, and SPORTDiscus databases searched from 1996-2006. Studies were retrieved that included patients with shoulder pain who underwent at least 1 clinical shoulder test for SLAP lesions. For an article to be included in this review, the results of the clinical tests needed to be compared with findings on arthroscopy. Quality of the manuscripts included in this review were rated using the QUADAS appraisal tool, so comparisons could be made across studies. Seventeen published manuscripts fit the inclusion/exclusion criteria and were used for this review. Eight studies were found to be of high quality. Within these 8 studies, 1 group of authors reported high diagnostic accuracy values for the crank test: sensitivity, 91% (95% confidence interval [CI], 76%-97%); specificity, 93% (95% CI, 79%-88%); positive likelihood ratio, 13.6 (95% CI, 3.6-52.1); and negative likelihood ratio, 0.1 (95% CI, 0.0-0.3). One study on the resisted supination external rotation test also scored high on the QUADAS and reported diagnostic accuracy values of 83% (95% CI, 66-92), 82% (95% CI, 52-95), 4.6 (95% CI, 1.3-16.1), and 0.20 (95% CI, 0.1-0.5), respectively. Of significance is the fact that the majority of papers reporting highly accurate clinical diagnostic tests were of low quality with the results not supported by other authors. It appears that no single test is sensitive or specific enough to determine the presence of a SLAP lesion accurately. Further research is required to determine whether subgrouping of patients by mechanism of injury or the type of SLAP lesion may improve diagnostic accuracy. Determining the diagnostic accuracy of a combination of 2 or more tests is also needed.

Simulated Type II Superior Labral Anterior Posterior Lesions Do Not Alter the Path of Glenohumeral Articulation

Background Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. Purpose To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. Study Design Controlled laboratory study. Methods Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30°, 60°, 90°, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. Results A subtle but significant increase in external rotation (2.7°) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. Conclusion The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion model as quantified by the path of glenohumeral articulation. Clinical Relevance Findings suggest that in the absence of pain or mechanical symptoms, type II superior labral anterior posterior lesions that do not significantly involve the superior and middle glenohumeral ligaments may not need surgical repair.

Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms

Superior labral anterior posterior (SLAP) lesions of the shoulder arise from various causes and have some controversies in their treatment. The purpose of this study is to evaluate the outcomes of arthroscopic SLAP repair and the relationship between injury mechanisms and outcomes. We evaluated the clinical results of 24 patients (mean 33 months follow-up) who had an arthroscopic isolated SLAP (type II: 21, type III: 1, type IV: 2 patients) repair with suture anchors. These labral tears were arthroscopically repaired with 1-4 anchors (mean 1.8). All patients were evaluated with University of California, Los Angeles (UCLA) and Visual Analogue Scale (VAS) scores. There were the following injury mechanisms: compression-type, 10; traction-type, 9; combined or other-type, 5 patients. We also compared the clinical results according to the injury mechanisms. Preoperatively, the mean of UCLA and VAS scores were 22.7 and 6.4 points, respectively. At an average of 33 months postoperatively, the mean of UCLA and VAS scores were 29.9 and 2.1 points, respectively. There was statistical improvement in the subjective scores from the pre- to post-operation. UCLA and VAS scores of the pre- and post-operation were not statistically different according to the injury mechanisms. Arthroscopic repair is effective in the treatment of isolated SLAP lesion and injury mechanisms do not affect the clinical outcomes.

Diagnostic Accuracy of Clinical Testing for Superior Labral Anterior Posterior Lesions: A Systematic Review

Diagnostic Accuracy of Clinical Testing for Superior Labral Anterior Posterior Lesions: A Systematic Review

Physical Examination and Magnetic Resonance Imaging in the Diagnosis of Superior Labrum Anterior-Posterior Lesions of the Shoulder: A Sensitivity Analysis

The overall purpose of our study was to examine the sensitivity of physical examination, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrogram for the identification of arthroscopically confirmed SLAP lesions of the shoulder. An analysis of 51 consecutive patients with arthroscopically confirmed SLAP lesions and no history of shoulder dislocation was performed. Before undergoing surgery, all patients underwent a standardized physical examination and had either an MRI and/or MR arthrogram performed. Sensitivity analysis was then performed on the results of both the physical examination maneuvers and the radiologic imaging compared to the arthroscopic findings at surgery. The sensitivity of O'Brien's (active compression) test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe's relocation test was 76%. The sensitivity of a physical examination with any 1 of these 3 SLAP provocative tests being positive was 100%. Neer's sign (41%) and Hawkin's impingement tests (31%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 67% when interpreted by the performing surgeon, 53% when read by a radiologist. When the MR arthrograms were analyzed alone, the sensitivity was 72% (surgeon) and 50% (radiologist), respectively. All 3 physical examination maneuvers traditionally considered provocative for SLAP pathology (O'Brien's, Mayo shear, and Jobe's relocation) were sensitive for the diagnosis of SLAP lesions. MRI and MR arthrogram imaging had lower sensitivity than these physical examination tests in diagnosing SLAP lesions. Patient history, demographics, and the surgeon's physical examination should remain central to the diagnosis of SLAP lesions. Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.

First‐time shoulder dislocation: High prevalence of labral injury and age‐related differences revealed by MR arthrography

To evaluate abnormalities and age-related differences after first-time shoulder dislocation. MRA images of first-time dislocators were assessed for labral-ligamentous-capsular / rotator cuff abnormalities and analyzed the age-related differences (< and >/=30 years old). Sixty-six patients (34 <30 years old vs. 32 >/=30 years; 51 males; all anterior dislocations) were imaged. Forty-eight patients (73%) showed anteroinferior labral avulsion, consisting of: 6% (4/34 vs. 0/32) Perthes; 23% (8/34 vs. 7/32) free ALPSA (anterior labrum periosteal sleeve avulsion) lesion); 6% (1/34 vs. 3/32) adherent ALPSA; 23% (9/34 vs. 6/32) Bankart; 14% (5/34 vs. 4/32) inferiorly displaced avulsed labrum; 2% (1/34 vs. 0/32) GLAD. Extensive labral detachment (extended above 3 o'clock position) was present in 31% (11/28 vs. 4/20). There were 14% (6/34 vs. 3/32) superior labrum anterior-posterior (SLAP) lesion; 27% (1/34 vs. 17/34) rotator cuff tendon tear; 71% (25/34 vs. 22/32) Hill-Sachs defect. Young patients were more likely to have extensive labral avulsions (P = 0.054), but less likely to have rotator cuff tears (P < 0.001). A high prevalence and wide variety of labral avulsions after first-time shoulder dislocation, especially adherent ALPSA, inferiorly displaced avulsed labrum, or GLAD lesion, may influence treatment choice and outcome, suggesting a role for early MRA to assist in treatment triage.

Arthroscopic Capsulolabral Reconstruction of the Type VIII Superior Labrum Anterior Posterior Lesion

Background A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability. Hypothesis Arthroscopic capsulolabral reconstruction is effective in alleviating pain and restoring stability and function in athletes with glenohumeral instability due to the type VIII superior labrum anterior posterior lesion. Study Design Case series; Level of evidence, 4. Methods From 2003 to 2006, 23 shoulders in 23 athletes were diagnosed with a type VIII superior labrum anterior posterior lesion by physical examination, magnetic resonance arthrography, and arthroscopy. All were treated with an arthroscopic capsulolabral reconstruction. Ten patients were involved in rehabilitation less than 9 months after surgery and were not included in this study. Thirteen remaining shoulders in 13 athletes with a mean age of 27.8 ± 10.9 years were analyzed at a mean follow-up of 24 months. Shoulders were evaluated preoperatively and postoperatively using the American Shoulder and Elbow Surgeons scoring system and standard subjective scales for stability, strength, function, and range of motion. Results Athletes most commonly participated in sport at the recreational level (n = 8), followed by collegiate (n = 3) and high school (n = 2). The most common activity was weight lifting (n = 4). Eight athletes (62%) participated in contact sports, most commonly football and wrestling. Two patients (15%) had a partial-thickness articular-sided supraspinatus tendon tear that was debrided at the time of surgery. Mean American Shoulder and Elbow Surgeons score improved from 51.4 to 90.0 (P < .001). There were significant improvements in stability, pain, function, and range of motion based on standardized subjective scales (P < .001). No shoulder required revision surgery for recurrent instability. All patients were able to return to sports, with 9 (69%) able to return to their highest level before surgery. Conclusion Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for glenohumeral instability due to a type VIII superior labrum anterior posterior lesion in the contact, noncontact, and throwing athlete. Successful postoperative return to sport is a reasonable expectation.

The Passive Compression Test

Background Even though there are several physical tests available for superior labrum anterior posterior lesions, there have been very few reports on their accuracy, and none can be regarded as completely predictive for the presence of a superior labrum anterior posterior lesion in the shoulder joint. Hypothesis This new clinical test is a useful and accurate technique for detecting superior labral tears in the shoulder joint. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods This test was conducted independently by 2 physicians before any other diagnostic evaluation. In all cases, the glenohumeral joint was investigated first, and the appropriate treatments were performed on the lesion. A protocol was established to evaluate the sensitivity, specificity, and positive and negative predictive values of this new clinical test. The reproducibility of this test was evaluated with a κ coefficient. Results Sixty-one patients (61 shoulders) were examined with the passive compression test, and all underwent arthroscopic surgery. In 31 patients with a positive passive compression test result, 27 had a superior labrum anterior posterior lesion, and in 30 patients with a negative passive compression test result, 6 had a superior labrum anterior posterior lesion. The sensitivity of the test was 81.8%, and the specificity was 85.7%. The positive predictive value was 87.1%, and the negative predictive value was 80.0%. The κ coefficient was 0.771 between the 2 independent examiners (P < .01). Conclusion The passive compression test is a useful and accurate technique for predicting superior labral tears of the shoulder joint.

Superior Labrum Anterior Posterior Lesions in the Overhead Athlete: Current Options for Treatment

Superior labrum anterior posterior (SLAP) lesions are a common occurrence in today’s active society. These lesions can result in significant pain and dysfunction around the shoulder. Since they were first described more than 20 years ago, there have been many different treatment options described, depending on the type of SLAP tear encountered. This article will review the anatomy, classification, diagnosis, treatment, and rehabilitation after surgical treatment for SLAP lesions. The article will also review the authors’ preferred surgical technique for addressing SLAP tears in overhead-throwing athletes.

Outcomes of Combined Arthroscopic Rotator Cuff and Labral Repair

Background Rotator cuff tears, Bankart lesions, and superior labral anterior posterior lesions commonly occur in isolation, but there is a subgroup of patients who experience combined injuries. Prior studies have excluded such patients as confounding groups. Hypothesis In patients with combined lesions of the labrum and rotator cuff, arthroscopic repair of both lesions will restore range of motion and stability and provide good clinical results. Study Design Cohort study; Level of evidence, 3. Methods We retrospectively evaluated the clinical outcomes of a series of patients with combined rotator cuff and labral (Bankart or superior labral anterior posterior) lesions treated arthroscopically. Results Thirty patients (average age, 47.8 years) with combined rotator cuff and labral lesions were evaluated at a mean follow-up of 2.7 years (range, 24-54 months). Sixteen patients had Bankart lesions and 14 patients had SLAP lesions. Significant improvements in forward flexion (20.5°, P = .005), external rotation (9.0°, P = .008), and internal rotation (2 vertebral levels, P = .016) were observed. The mean L'Insalata and American Society of Shoulder and Elbow Surgeons scores for all patients were 92.9 and 94.3, respectively. Twenty-seven (90%) patients reported satisfaction as good to excellent, and 23 of 30 (77%) returned to their preinjury level of athletics. Two patients suffered recurrent rotator cuff tears. Conclusion In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction.

A Biomechanical Comparison of Suture Anchor Placement on Repair Strength for Type II Superior Labral Anterior Posterior (SLAP) Lesions (SS-34)

To evaluate the biomechanical repair strength of two different suture anchor configurations utilized for type II superior labral anterior posterior (SLAP) lesions. Standardized type II SLAP lesions were created in eight match paired cadaveric shoulders using a previously established protocol. Two different suture anchor configurations were used to repair the SLAP lesion. One arrangement (n=8) placed a suture anchor anterior and another posterior to the biceps labral insertion; a second arrangement (n=8) placed two suture anchors posterior to the biceps labral insertion. Specimens were mounted and a posterior directed load was applied to generate displacement of the biceps tendon. The mean load required to displace the biceps labral insertion 2mm was 35.8N after repair of a type II SLAP lesion with a suture anchor placed anterior and one posterior (AP repair). SLAP lesions repaired with two suture anchors placed posterior (PP repair) to the biceps insertion required a mean load of 46.7N to displace the biceps labrum insertion 2mm. When measuring load on the biceps anchor to cause 2mm of displacement, there was no significant difference in repair strength of type II SLAP lesions using the two different suture anchor configurations.

Physical Exam and Magnetic Resonance Imaging (MRI) in the Diagnosis of Superior Labrum Anterior-Posterior (SLAP) Lesions of the Shoulder (SS-50)

There is limited data comparing the sensitivity of physical examination and MR imaging in the diagnosis of arthroscopically confirmed glenoid labral lesions. A review of 50 consecutive patients with arthroscopically confirmed superior labrum anterior-posterior (SLAP) lesions and no history of shoulder dislocation was performed. The study was prospectively designed with IRB approval. All patients underwent a standardized physical examination that was compared to the official radiologist’s report of MR and/or MR arthrogram imaging. Sensitivity analysis was performed. To determine a difference in sensitivity of 8% between testing modalities, a pre-study power analysis determined that the minimal sample size was 25 patients (for a study with a power of 0.80 and an alpha of 0.05). The sensitivity of O’Brien’s active compression test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe’s relocation test was 76%. The sensitivity of a physical exam with any one of these three tests being positive was 100%; the sensitivity of requiring at least two positive tests ranged from 64% - 72%, and the sensitivity decreased to 58% if all three of these maneuvers was deemed necessary for the diagnosis. Neer (42%) and Hawkin’s impingement tests (32%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 68% when interpreted by the performing surgeon, 54% when read by a radiologist. When the gadolinium enhanced MRI’s were analyzed as a subset (performed in 17 patients), the sensitivity was 76% (surgeon) and 52% (radiologist), respectively. O’Brien’s test was highly sensitive while the Mayo shear and Jobe’s relocation tests had good sensitivity in the diagnosis of SLAP lesions. MR and MR arthrogram imaging had a lower sensitivity than these examination tests in diagnosing SLAP lesions. Patient history and physical examination remain central to the diagnosis of glenoid labral lesions. While MRI is not as sensitive, it remains an adjunct for the clinician in treating these patients.

Clinical Assessment of Superior Glenoid Labral Lesions

Superior labral anterior posterior (SLAP) lesions of the glenoid have proven difficult to diagnose clinically. SLAP-lesion-specific physical examination tests have been developed to improve clinical acumen. Initial reported performance of these tests has not been reproduced by independent investigation. We hypothesized SLAP-specific physical examination tests could not provide a definitive diagnosis of a SLAP lesion. We further intended to elucidate factors responsible for the variable performance of SLAP-specific tests. A review of the literature through Medline and Embase database searches was conducted. All studies with level of evidence of III or better involved in the reporting of diagnostic accuracy of SLAP-specific physical examination tests were included and reviewed. Each instance of independent evaluation of a SLAP-specific examination showed poorer examination performance than in the originating study. Considerable variability existed between independent evaluations of a given SLAP-specific examination as well. We concluded SLAP-specific physical examination results cannot be used as the sole basis of a diagnosis of a SLAP lesion. Differences in patient populations between studies and the accompanying differences in SLAP lesion prevalence and comorbid conditions played the greatest role in test result variance.

Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions

Physical examination tests that place tension on the long head of the biceps may best reproduce symptoms in patients with type II superior labrum anterior-posterior (SLAP) lesions. The objective of this study is to compare the normalized electromyographic signal of the long head of the biceps for SLAP lesion physical examination tests. The active compression test, anterior-superior SLAP test, biceps load test II, biceps tension test, and pain provocation test were performed on 13 subjects while biceps electromyographic data were recorded. The active compression test and biceps tension test had significantly higher electromyographic signals than the other tests. We found no significant differences when comparing forearm supination and pronation within individual tests. Because the active compression and biceps tension tests maximize muscle activation on the long head of the biceps, they may be the best physical examination tests by which to identify type II SLAP lesions.

Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: Eighty-three arthroscopically confirmed cases

Magnetic resonance imaging (MRI) has been shown in the literature to have high accuracy for the diagnosis of superior labrum anterior-to-posterior (SLAP) lesions. However, these studies have been performed at specialized institutions and have not been evaluated for community settings. Our hypothesis was that MRI diagnosis of SLAP lesions in the community setting is not as accurate as suggested by previous literature. The MRI reports for 83 consecutive surgically confirmed type II SLAP lesions were evaluated. The findings regarding the presence of SLAP lesions were documented from the community radiologists' MRI readings. Two blinded, fellowship-trained musculoskeletal radiologists evaluated these same 83 MRIs, as well as 17 MRIs with surgically confirmed normal superior labra. The musculoskeletal radiologists also used a visual analog scale to subjectively grade the quality of each MRI. MRIs were performed at 14 different centers and were read by 28 different community radiologists. There were 37 noncontrast MRIs and 46 MRI arthrograms. The community radiologists accurately identified 51% of the SLAP lesions. The sensitivities for the community radiologists were significantly better for the MRI arthrograms than for the noncontrast MRIs (P = .0002). For the two musculoskeletal radiologists, the sensitivities were 60% and 67.5%, and the specificities were 71% and 76.5%. The accuracies for the musculoskeletal radiologists were 62% and 69%. One of the musculoskeletal radiologists had significant correlation between the visual analog score and MRI diagnostic accuracy (P = .0006). The sensitivity for one of the musculoskeletal radiologists was significantly greater than the sensitivity for the community radiologists (P = .0063). The accuracies between the other musculoskeletal radiologist and the community radiologists were not significantly different (P = .0577). In this community setting, MRI was not accurate for the diagnosis of SLAP lesions. Musculoskeletal radiologists were more accurate than the community radiologists; however, the musculoskeletal radiologists were not as accurate as previous literature might predict.