Which of the following is the most likely etiology of his complaints? Post-operatively he complains of burning pain in the region marked in yellow on Figure B. Which of the following nerves was most likely injured during the procedure? Posterior Labral Tear. Ashley Bassett. Kevin Farmer. American Shoulder and Elbow Surgeons. A posterior labral tear is referred to as a reverse Bankart lesion, or attenuation of the posterior capsulolabral complex, and commonly occurs due to repetitive microtrauma in athletes.
Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. A third type of labrum tear is in the area where the biceps tendon attaches to the upper end of the socket. The socket can be divided into four regions: anterior front , posterior back , superior the upper end near your head or inferior the lower end, which is toward the elbow.
The biceps tendon attaches at the superior end, where it blends in with the labrum. The labrum runs from there around the joint, both in an anterior and in a posterior direction. Due to injury in this area where the biceps tendon attaches, the labrum also can get injured. The injury in this area can be mild or it can be severe.
Because the injury typically involves the biceps tendon and the labrum, because it is at the superior end of the socket and because it can affect the labrum attachments anterior and posterior to where the biceps attaches in this region, the acronym or abbreviation for this injury is a SLAP lesion.
This stands for an injury that is superior labrum anterior and posterior. There have been several grading systems or classification systems of this injury. In a lesser injury, the labrum is only partially detached in this area.
In a more severe injury, the whole labrum is pulled off of the bone along with the biceps tendon. The most common classification divides SLAP lesions into four types. Because this cartilage is deep in the shoulder, it is very difficult to make the diagnosis of a torn labrum upon physical examination.
There are several tests that the physician can perform that may indicate a torn labrum, but these tests are not always accurate. The other problem is that labrum tears take different forms as described above, and certain tests will detect one kind of tear but not another. Some physicians feel very confident that they can make the diagnosis of a labral tear upon physical examination, but this is controversial.
There are not many scientific studies that show that physical examination is reliable for making the diagnosis of a labral tear. As a result of this uncertainty, other studies can be done to confirm the diagnosis if it is suspected. The best tests available to make the diagnosis of a labral tear are magnetic resonance imaging MRI scans or a test called a CT-arthrogram the latter is a CAT scan preceded by an arthrogram where dye is injected into the shoulder.
Both of these tests are relatively good at defining a labrum tear due to a subluxation or dislocation, but they are only around 80 percent to 85 percent accurate. For that reason, some physicians believe that tests are not always needed if the diagnosis of subluxation or dislocation can be made by history and physical examination.
Neither of those tests is currently very good at making the diagnosis of a SLAP lesion. This area is very complex and it is difficult to reliably get good pictures of this area with MRI. However, if the MRI definitely shows a tear then frequently it will be present.
The problem is that the MRI may miss smaller tears and cannot reliably make the diagnosis in larger tears of the labrum. The best way to make the diagnosis of labrum tearing is with arthroscopy of the shoulder. Unfortunately this is an operative procedure and requires some form of anesthesia. To make a tear in the labrum show up more clearly on the MRI, a dye may be injected into your shoulder before the scan is taken.
Left An MRI image of a healthy shoulder. Right This MRI image shows a tear in the labrum. In many cases, the initial treatment for a SLAP injury is nonsurgical. Treatment options may include:. Non-steroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling. Physical therapy. Specific exercises will restore movement and strengthen your shoulder.
Flexibility and range-of-motion exercises will include stretching the shoulder capsule, which is the strong connective tissue that surrounds the joint. Exercises to strengthen the muscles that support your shoulder can relieve pain and prevent further injury. This exercise program can be continued anywhere from 3 to 6 months, and usually involves working with a qualified physical therapist.
The surgical technique most commonly used for repairing a SLAP injury is arthroscopy. During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your shoulder joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions cuts , rather than the larger incision needed for standard, open surgery. During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint. Left An arthroscopic view of a healthy labrum.
Right The labrum has been reattached with sutures. Repair options. There are several different types of SLAP tears. These symptoms may vary depending on the type of labral tear a person has. Both types of tears are usually accompanied by aching pain and difficulty performing normal shoulder movements.
SLAP stands for "superior labrum from anterior to posterior. Stephen Fealy , an orthopedic surgeon in the Sports Medicine Institute. Patients with SLAP tears may experience pain at the front of the shoulder near the biceps tendon. Bankart tears typically occur in younger patients who have dislocated their shoulder. When the shoulder joint ball slips out of the socket, the joint capsule fiberous tissues that surround and protect the joint can pull on the lower portion of the labrum and tear it.
This in turn creates instability because the breached labrum makes it easier for the shoulder to dislocate again. A dislocation where the head of the humerus shifts toward the front of the body, it leads to what is called "anterior instability. With Bankart tears, patients may feel apprehension that the shoulder may slip out of place or dislocate in certain positions.
Unfortunately, labral tears are hard to prevent, especially in athletes, because the force of the overhead motion contributes to the injury. Although athletes are most prone to labral tears, people who experience a traumatic event — such as falling down a flight of stairs — are also at risk.
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