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SLAP Tears

SLAP Tears. Eric L. Chehab, MD January 20, 2010. SLAP Tears. SLAP Tears. Snyder 1990 coined the term “SLAP” Superior labrum anterior and posterior 27 lesions in 700 shoulder arthroscopies (3.9%) MOI: Compression onto outstretched arm Symptoms: Pain, overhead pain, catching/popping

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SLAP Tears

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  1. SLAP Tears Eric L. Chehab, MD January 20, 2010

  2. SLAP Tears

  3. SLAP Tears • Snyder 1990 coined the term “SLAP” • Superior labrum anterior and posterior • 27 lesions in 700 shoulder arthroscopies (3.9%) • MOI: Compression onto outstretched arm • Symptoms: Pain, overhead pain, catching/popping • Divided into 4 types (most common classification used today)

  4. Type I

  5. Type II

  6. Type III

  7. Type IV

  8. Labrum Anatomy • Fibrocartilage • Blood supply • Shape

  9. Labrum Anatomy

  10. Labrum Anatomy

  11. Labrum Anatomy

  12. Labrum Anatomy Sr = Synovial recess, G = glenoid

  13. Labrum Anatomy • Like the meniscus, the blood supply to the labrum dictates treatment • High variability in the normal anatomy can make pathologic conditions in the labrum more difficult to identify

  14. Labrum Function Cutting Study – Cadaveric lesions created to study function Pagnani MJ. JBJS. 1995

  15. Labrum Function Pagnani MJ. JBJS. 1995

  16. Labrum Function Pagnani MJ. JBJS. 1995

  17. Labrum Function Repair of full lesion restores stability to joint in cadavers Pagnani MJ. JBJS. 1995

  18. Labrum Function • Increases concavity and compression • Stabilizes shoulder anterior-posteriorly and superiorly/inferiorly • Improves rigidity of the shoulder in the cocked, throwing position (ie loads the gun)

  19. Mechanism of Injury • Baseball, javelin, football, tennis, softball • Tremendous force with late cocking, deceleration phase of throwing • Repetitive micro trauma • Fall with direct compression on forward flexed arm

  20. Mechanism of Injury • Predisposing factors • Peel – back • Capsular contracture (essential lesion) • Internal impingement • Increased glenoid retroversion

  21. Fig. 3 Schematic and graphical representations of the humeral shift from neutral to maximum external rotation, showing the superior shift of the humeral head following the simulated posterior capsular contracture. Grossman M. G. et.al. J Bone Joint Surg 2005:87:824-831

  22. Mechanism of Injury • Native shoulder – head shifts posteroinferiorly in late cocking phase • With posterior contracture, anterior laxity from repetive throwing, head shifts posterosuperiorly, loading the labrum while under excess tension with increased ER. Labrum peels back and separates from glenoid rim attritionally.

  23. Clinical Presentation

  24. Thank You

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