Superior Labrum Anterior- Posterior Lesions: Diagnosis with MR Arthrography of the Shoulder1 (original) (raw)
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.
SLAP lesions: Anatomy, clinical presentation, MR imaging diagnosis and characterization
European Journal of Radiology, 2008
Superior labral anterior posterior (SLAP) tears are an abnormality of the superior labrum usually centered on the attachment of the long head of the biceps tendon. Tears are commonly caused by repetitive overhead motion or fall on an outstretched arm. SLAP lesions can lead to shoulder pain and instability. Clinical diagnosis is difficult thus imaging plays a key diagnostic role. The normal anatomic variability of the capsulolabral complex can make SLAP lesions a diagnostic challenge. Concurrent shoulder injuries are often present including rotator cuff tears, cystic changes or marrow edema in the humeral head, capsular laxity, Hill-Sachs or Bankart lesion. The relevant anatomy, capsulolabral anatomic variants, primary and secondary findings of SLAP tears including MR arthrography findings, types of SLAP lesions and a practical approach to labral lesions are reviewed.
Diagnostics
We aimed to evaluate the diagnostic performance of shoulder MR arthrography (MRA) acquired in the neutral (N), internal rotation (IR), and external rotation (ER) positions of the shoulder to detect SLAP lesions. Three observers evaluated 130 MRAs to detect SLAP lesions and to calculate labral diastasis in this triple-blinded study. Sensitivity was much higher in the ER (92.5–97.5%) than in the N (60–72.5%) and IR (42.5–52.5%) positions, and the specificity of all the reviewers was 100% in all the positions. The diagnostic accuracy was higher in the ER too (97.7–99.2%). The diastasis length was significantly higher in the ER (median = 2.5–2.8 mm) than in the N (1 mm) and IR (0 mm) positions and was also significantly higher in those patients requiring surgery (p = 0.001). The highest inter-rater agreement values were observed in the ER both in SLAP detection (k = 0.982) and the diastasis length evaluation (ICC = 0.962). The diastasis length threshold in the ER that best separated the...
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 ...
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.
Normal anatomy and common labral lesions at MR arthrography of the shoulder
Clinical Radiology, 2006
MR arthrography of the shoulder is the most accurate imaging modality in demonstrating abnormalities of the glenoid labrum and associated structures. Tears of the labrum, the capsule or the gleno-humeral ligaments can lead to pain, catching, popping or instability. The anatomy of this region is complex. We present the normal anatomy of the glenoid labrum, biceps anchor and gleno-humeral ligaments together with their normal variants and then describe common labral-ligamentous pathologies.
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...
The American Journal of Sports Medicine, 2009
Glenoid labral tears involving the long head of the biceps were initially described by Andrews et al 2 in 1985, who noted an association between these lesions and overhead sports activities. In 1990, Snyder et al 33 further classified these labral tears and coined the term "SLAP lesion" for superiorlabrum-anterior-and-posterior (SLAP) lesion. Their prevalence varies depending on the patient population studied but has been reported to be between 1.2% and 23%. However, their cause is often uncertain. Other than a distinct traumatic event, sporting activities are the most common cause of SLAP lesions. Type II SLAP lesions correspond to a detached biceps anchor from the superior glenoid, accounting for the majority of described SLAP lesions (41%) and occur most commonly in overhead athletes. 4,23,32,33 Although such lesions are often associated with other shoulder injuries such as rotator cuff tears, glenohumeral instability, or Background: Overhead athletes report an inconsistent return to their previous level of sport and satisfaction after arthroscopic SLAP lesion repair.