Clinical and Imaging Assessment for Superior Labrum Anterior and Posterior Lesions (original) (raw)
Related papers
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2008
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. Methods: 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. Results: 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. Conclusions: 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 of Evidence: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
Journal of Shoulder and Elbow Surgery, 2012
Background: The clinical diagnosis of a superior labral anterior posterior (SLAP) tear is extremely challenging. Most studies that advocate selected tests have errors in study design or significant bias, or both. The purpose of this study was to identify the diagnostic utility of the Active Compression/O'Brien's test, Biceps Load II test, Dynamic Labral Shear test (O'Driscoll's test), Speed's test, and the Labral Tension test when diagnosing isolated SLAP lesions (SLAP-only) and a SLAP lesion with concomitant disorders (eg, rotator cuff tear), as stand-alone and clustered tests, with diagnostic confirmation by arthroscopic surgery. Materials and methods: This diagnostic accuracy study was a case-based, case-control design that included 87 individuals with variable shoulder pathology. Results: Of the 5 tests, only the Biceps Load II test demonstrated utility in identifying patients with a SLAP-only lesion, with a positive predictive value of 26 (95% confidence limits [CL], 18, 31), negative predictive value of 93 (95% CL, 84, 97), positive likelihood ratio of 1.7 (95% CL, 1.1, 2.6), and negative likelihood ratio of 0.39 (95% CL, 0.14, 0.91). No tests demonstrated diagnostic utility when diagnosing any SLAP lesion, including those with concomitant diagnoses. No clusters demonstrated better diagnostic accuracy than stand-alone findings. Conclusion: There are a number of potential reasons for the poor utility in the 5 test findings. The heterogeneous sample included patients with a variety of shoulder disorders. The study was organized using very strict methodologic controls that should reduce the risk of bias, which normally overinflates the accuracy of a specific tool. The findings may truly reflect the stand-alone, diagnostic utility of the 5 tests, suggesting when used alone provides little usefulness toward decision making of the diagnostic clinician.
Posttraumatic persistent shoulder pain: Superior labrum anterior-posterior (SLAP) lesions
The American journal of case reports, 2013
Male, 57 FINAL DIAGNOSIS: Typ 2 Superior labrum anterior-posterior lesion Symptoms: Shoulder pain after trauma Medication: - Clinical Procedure: - Specialty: Orthopedics and Traumatology • Emergency Medicine. Rare disease. Due to the anatomical and biomechanical characteristics of the shoulder, traumatic soft-tissue lesions are more common than osseous lesions. Superior labrum anterior-posterior (SLAP) lesions are an uncommon a cause of shoulder pain. SLAP is injury or separation of the glenoid labrum superior where the long head of biceps adheres. SLAP lesions are usually not seen on plain direct radiographs. Shoulder MRI and magnetic resonance arthrography are useful for diagnosis. A 57-year-old man was admitted to the emergency department due to a low fall on his shoulder. In physical examination, active and passive shoulder motion was normal except for painful extension. Anterior-posterior shoulder x-ray imaging was normal. The patient required orthopedics consultation in the em...
Superior Labral Anterior Posterior Lesions of the Shoulder
The Open Orthopaedics Journal, 2013
Superior labrum anterior and posterior (SLAP) lesion is of fairly recent description and its understanding is rapidly evolving. Its incidence and need for surgical treatment has increased exponentially in line with the increase in shoulder arthroscopies. It is of particular importance in the elite over head athlete and the young. A range of arthroscopic techniques and devices have been described with good functional results. The ability to return to pre injury level of sports remains a concern.
Diagnosis of Lesions of the Shoulder Joint Using Magnetic Resonance Imaging
Background: This retrospective study reports the types, frequency, and relationships of lesions affecting a malfunctioning shoulder joint. Aims: Determination of the frequency and mutual relationships of lesions of the shoulder joint in cases of malfunction. Methods: In a set of 79 patients, which consisted of 55 men and 24 women sent for an MRI during a period of 14 months, we retrospectively evaluated the frequency and mutual relationships between lesions of the structures of the shoulder joint, specifically: lesions of the long head of the biceps tendon; superior labral tear from anterior to posterior (SLAP) lesions; glenohumeral traumatic changes; glenohumeral degenerative changes; acromioclavicular degenerative changes; acromioclavicular traumatic changes; pathological bursae, and lesions of the glenohumeral and acromioclavicular ligaments. We evaluated the frequency of representation of subacromial, subcoracoid, and posterosuperior impingements. Results: 30.4% of the patients ...
Surgical and Radiologic Anatomy, 1998
The ability to detect and categorize SLAP (Superior Labrum Anterior to Posteliol-) lesions of the scapular labrum is of practical importance to the orthopedic surgeon and the radiologist. The aim of this study, performed on cadaveric shoulders, was to determine whether CT arthrography or MR arthrography is abIe to show normal anatomical variation of the glenoid labrum and detect labral abnormalities, CT arthrography, MR arthrography followed by anatomical dissection were performed on twenty three fresh frozen cadaveric shoulders and analysed by a radiologist and two orthopaedic surgeons. As Gadolinium intra-articular injection is not allowed in France, we used an iodinated contrast media for both MR arthrography and CT arthrography. In this study, the sensitivity of MR arthrography seemed higher than CT arthrography (respectively 4 and 3 labral lesions diagnosed out of five), although no significant statistical conclusions can be made due to the small number of cases. In conclusion, under such specific conditions, MR arthrography seems to be the method of choice for the detection and classification of labral lesions.