- See: proximal
biceps tendonopathy
- Discussion:
- refers to a detachment lesion of the superior aspect of glenoid
labrum, which serves as the insertion of long head of
biceps;
- relatively common injury in
throwing
atheletes, but may most commonly occur in patients who have fallen or who
have received a blow on the shoulder;
- references:
-
Kinetics of baseball pitching with implications about injury mechanisms.
-
A Cadaveric Model
of the Throwing Shoulder: A Possible Etiology of Superior Labrum
Anterior-to-Posterior Lesions.
-
Failure of biceps superior labral complex: A cadaveric biomechanical
investigation comparing late cocking and early deceleration positions of
throwing.
- The role of long
head of biceps muscle and superior glenoid labrum in anterior stability of the
shoulder. Am J. Sports Med. Vol 22. 1994. p 121-130.
-
Effect of lesions of the superior portion of the glenoid labrum on
glenohumeral translation.
- varient anatomy:
- in 50% of
patients, biceps predominately attaches to supraglenoid tubercle where as in
other half biceps predominately attaches to superior labrum;
- slight detachment
of the superior posterior labrum may be normal in older aults;
- Buford
complex: (see
shoulder capsule)
- anatomical variant: MGHL ligament appears cord-like and will often be frayed
and is often associated w/ a physiologic antero-superior sublabral hole;
- glenoid labrum opposite of the MGHL will often be absent;
- attempts to close down this sub-labral hole w/ a absorable tack anchor may
precipitate frozen shoulder;
- in most cases a SLAP lesion will show infammatory changes around the biceps
tendon origin;
- arthroscopic findings: (true slap vs normal findings)
- glenoid chondromalacia in the area of detachment, with corresponding fraying
on the underside of the detached labrum and glenoid;
- anterior cannula may be used to hold labrum against the glenoid while the
shoulder is externally rotated;
- normal variants will pop free with external rotation, while tears can be held
inplace;
- references:
- Buford complex: "cord like" MGHL and absent anterosuperior labrum complex: a
normal anatomic capsulolabral variant. Arthroscopy 10: p 241-247. 1994.
-
Relationship between the tendon of the long head of biceps brachii and the
glenoidal labrum in humans.
-
Normal variations of the glenohumeral ligament complex: an anatomic study for
arthroscopic bankart repair.
- Anatomical
Variants in the Anterosuperior Aspect of the Glenoid Labrum.
-
Repair of SLAP Lesions Associated With a Buford Complex: A Novel Surgical
Technique
- associated conditions:
-
rotator cuff
pathology is present in 40%;
-
anterior instability:
- ref:
Risk of motion loss with combined Bankart and SLAP repairs.
- spinoglenoid
cysts
- Treatment of
Labral Tears with Associated Spinoglenoid Cysts without Cyst Decompression
- Radiographic Findings:
- references:
-
Injuries of the superior portion of the glenoid labrum involving the
insertion of the biceps tendon: MR imaging findings in nine cases.
-
Labral injuries: accuracy of detection with unenhanced MR imaging of the
shoulder.
- Clinical Findings:
- pain w/ overhead activity which may mimic
impingement syndrome (see
throwing
shoulder)
- mechanicals symptoms;
- references:
-
The
Resisted Supination External Rotation Test. A New Test for the Diagnosis of
Superior Labral Anterior Posterior Lesions.
-
The SLAP lesion: a cause of failure after distal clavicle resection
-
A clinical test for superior glenoid labral or 'SLAP' lesions.
- Classification and Treatment:
- type I:
- fraying and degeneration of the superior labrum, normal
biceps (no detachment);
- most common type of SLAP tear (75% of SLAP tears);
- often associated with
rotator cuff
tears;
- these are treated w/ debridement;
- type II:
- detachment of superior labrum and biceps insertion from
the supra-glenoid tuberlce;
- when traction is applied to the biceps, the labrum arches away
from the glenoid;
- typically the
superior and middle glenohumeral ligaments are unstable;
- may resemble a normal variant (Buford complex);
-
3 subtypes: based on detachment of labrum
involved anterior aspect of labrum alone, the posterior aspect alone, or both
aspects;
- posterior labram tears may be caused by impingement of cuff
against the labrum with the arm in the abducted and externally rotated position;
- as noted by
Tae Kyun Kim et al. type-II lesions in patients older than 40 years of age
were associated with a supraspinatus tear where as
in patients younger than 40 years were associated with
participation in overhead sports and a Bankart lesion;
- treatment involves anatomic arthroscopic repair;
- references:
-
Biomechanical analysis of isolated type II SLAP lesions and repair.
-
Type II SLAP lesions: three subtypes and their relationships to superior
instability and rotator cuff tears.
-
Ganglion cysts of the shoulder: technique of arthroscopic decompression and
fixation of associated type II SLAP lesions.
-
Shoulder injuries in overhead athletes. The "dead arm" revisited.
-
Differences
in Ultimate Strength of the Biceps Anchor and the Generation of Type II SLAP
Lesions in a Cadaveric Model.
-
Treatment of Labral
Tears with Associated Spinoglenoid Cysts without Cyst Decompression
-
Arthroscopic Treatment of Concomitant Superior Labral Anterior Posterior (SLAP)
Lesions and Rotator Cuff Tears in Patients Over the Age of 45 Years
-
Outcomes After
Arthroscopic Repair of Type-II SLAP Lesions
-
A biomechanical comparison of two suture anchor configurations for the repair of
type II SLAP lesions subjected to a peel-back mechanism of failure.
-
Quantifying the extent of a type II SLAP lesion required to cause peel-back of
the glenoid labrum--a cadaveric study.
- type III:
- bucket handle type tear;
- biceps anchor is intact;
- type IV
- vertical tear (bucket-handle tear) of the superior
labrum, which extends into biceps (intrasubstance tear);
- may be treated w/ biceps tenodesis if more than 50% of the tendon
is involved;
- Arthroscopic Technique: - see:
shoulder arthroscopy:
-
anterior portal
- anterior portal needs to be positioned along superior aspect of
the rotator interval anteriorly and slightly superior to the biceps tendon;
- second portal is made just above the subscapularis;
- transtendon portal:
-
Percutaneous SLAP
Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington
- labral exposure:
- consider passing a heavy suture under the labrum and
bringing both ends of the suture out of the end of the canula;
- tension is kept
constant by applying a clamp over the sutures at the end of the canula.
- this will keep
the labram out of the way while drilling and suture passage is completed.
- once the labrum is ready to be secured, tension on the stay suture
is released;
- anchor position:
- goal is insertion
within the superior glenoid tubercle;
- consider hand
tamping the drill bit instead of power drilling, so that the drill bit will not
skive;
- posterior
fixation:
-
A biomechanical comparison of two suture anchor configurations for the repair of
type II SLAP lesions subjected to a peel-back mechanism of failure.
-
arthroscopic knots: