Pathophysiology
Fibrocartilage of the shoulder joint, anchoring the joint capsule and shoulder ligaments |
Often by single trauma, or repeated microtrauma |
Plays a role in proprioception, aiding muscular control, and acts as a washer, spreading loads equally over the interface |
Labrum is the primary attachment site for the shoulder capsule and glenohumeral lig |
Epidemiology
From 35, the superior labrum is less firmly attached to the glenoid than people under 30 |
30-50: more chances of tears/defects in the superior and anterior-superior regions of the labrum |
60 or older: circumferential lesions |
Common in volleyball, tennis, handball, and overhead activities |
Types
SLAP |
Superior labrum, four different types, stable or unstable |
Non-SLAP |
Degenerative, flap, and vertical labral tears and unstable lesions (ex. Bankart - anteriorly) |
Hill-Sachs lesion |
Impression fracture on the posterior humeral head (not technically a labral tear but may be in conjunction with Bankart lesion) |
MOI
SLAP |
repetitive throwing (pulls the biceps tendon), hyperextension, fall on outstretched arm, heavy lifting, direct trauma |
Bankart lesion |
repeated anterior shoulder subluxations |
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Prognosis
If conservative treatment successful, young athlete can expect full return to sport within 3-6 months |
Subjective Markers
Persistent deep seated shoulder pain |
Painful clicking, catching and grinding |
Sense of instability and distrust in the shoulder |
Pain localized to the posterior or posterior-superior joint line (especially in abduction) |
Objective Assessment
Observation |
?Shoulder dislocation |
Palpation |
Tenderness over anterior aspect of shoulder |
AROM/PROM |
Pain on resisted biceps contraction |
Strength |
No loss in strength, just pain |
Functional |
Throwing overhead (reproducing pain) |
Types of SLAP lesion
Type I |
Attachment of the labrum to the glenoid is intact but there is evidence of fraying and degeneration |
Type II |
Lesions involve detachment of the superior labrum and tendon of the long head of biceps from the glenoid rim |
Type III |
The meniscoid superior labrum is torn away and displaced into the joint but the tendon and its labral rim attachment are intact |
Type IV |
The tear of the superior labrum extends into the tendon, part of which is displaced into the joint along with the superior labrum |
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Rehab
Conservative management usually unsuccessful in all but the most minor SLAP lesions in younger sports people |
Bankart treated with arthroscopic fixation |
>50 surgical repair of SLAP lesion does not yield additional benefit over conservative treatment and therefore should be avoided |
Physio: focuses on scapular stabilization exercises and stretching program for the posterior capsule |
With compressive injury - caution with weight-bearing exercises |
With traction injuries - heavy weights should be avoided |
Goals: restore ROM, neuromuscular control, dynamic stability, and proprioception, full strength and endurance |
First step of conservative: abstain from aggravating activities to provide relief to pain and inflammation, NSAIDs or corticosteroid injections |
Regaining GIRD is crucial, may be by stretching |
Special Tests
Biceps load test II (specific) |
O'Brien test (sensitive) |
Anterior apprehension test (sensitive) |
Speeds Test (specific) |
Yergason's test (specific) |
Compression rotation test (sensitive) |
Dynamic labral shear test |
Imaging
MRI arthrography - high degree of reliability |
Common shoulder rehab
forward flexion in a side lying position |
prone extension |
seated rowing |
serratus punch (protraction with elbow extended) |
knee push-up plus |
forward flexion in external rotation and forearm supination |
full can (elevation in the scapular plane in ER) |
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