A 27-Year-Old Thrower with Failed Labral Repair

  • W. Ben Kibler


Overhead athletes with suspected labral injuries must be evaluated for the presence or absence of the clinically significant labral injury (CSLI), an anatomic labral injury that can be related to the clinical symptoms. This term is a more functional description of the pathoanatomy and can guide more precise treatment than the term superior labrum anterior to posterior. Surgical treatment of the labral injury should address all of the pathoanatomy without damage or restriction of the normal anatomy. This case illustrates pitfalls in treatment that may occur if these principles are not followed and how revision treatment can improve outcomes.

The original diagnosis of the labral injury focused only on the “superior” injured and guided treatment which failed to restore the normal anatomy and produced further disability. Detailed physical exam and imaging revealed the posterior component of the injury and determined that the biceps was not a factor in the dysfunction. Revision arthroscopic treatment addressed the posterior labral pathoanatomy and resulted in stable and acceptable functional outcomes for overhead activities. It did not include a biceps tenodesis, since the physical exam and arthroscopic evaluation did not indicate biceps pathology. Understanding the roles of the labrum in normal shoulder function and how the CSLI affects shoulder dysfunction can lead to improved evaluation and treatment methods.


Labrum Arthroscopy Failed surgery 


  1. 1.
    Uhl TL, Kibler WB, Gecewich B, Tripp BL. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25(11):1240–8.CrossRefGoogle Scholar
  2. 2.
    Kibler WB. The role of the scapula in athletic function. Am J Sports Med. 1998;26:325–37.CrossRefGoogle Scholar
  3. 3.
    Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the “scapula summit”. Br J Sports Med. 2013;47:877–85.CrossRefGoogle Scholar
  4. 4.
    Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The intertester reliability of the scapular assistance test. J Orthop Sports Phys Ther. 2006;36(9):653–60.CrossRefGoogle Scholar
  5. 5.
    Kibler WB, Sciascia AD, Dome DC. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med. 2006;34(10):1643–7.CrossRefGoogle Scholar
  6. 6.
    Kibler WB, Sciascia AD, Dome DC, Hester PW, Jacobs C. Clinical utility of new and traditional exam tests for biceps and superior glenoid labral injuries. Am J Sports Med. 2009;37(9):1840–7.CrossRefGoogle Scholar
  7. 7.
    O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26(5):610–3.CrossRefGoogle Scholar
  8. 8.
    Crenshaw AH, Kilgore WE. Surgical treatment of bicipital tenosynovitis. J Bone Joint Surgery Am. 1966;48A(8):1496–502.CrossRefGoogle Scholar
  9. 9.
    Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am. 1981;63-A(6):863–72.CrossRefGoogle Scholar
  10. 10.
    Neer CS, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. J Bone Joint Surg Am. 1980;62-A(6):897–908.CrossRefGoogle Scholar
  11. 11.
    Kibler WB, Sciascia A. Current practice for the diagnosis of a superior labral anterior to posterior (SLAP) lesion: systematic review and physician survey. Arthroscopy. 2015;31(12):2456–69.CrossRefGoogle Scholar
  12. 12.
    Kibler WB, Kuhn JE, Wilk KE, Sciascia AD, Moore SD, Laudner KG, et al. The disabled throwing shoulder - Spectrum of pathology: 10 year update. Arthroscopy. 2013;29(1):141–61.CrossRefGoogle Scholar
  13. 13.
    Kibler WB, Sciascia A. Current practice for the treatment of superior labral anterior to posterior (SLAP) lesions: a systematic review. Arthroscopy. 2016;32(4):669–83.CrossRefGoogle Scholar
  14. 14.
    Kibler WB. What is a clinically important superior labrum anterior to posterior tear? In: Pagano MW, Hart RA, editors. Instructional course lectures, vol. 62. Rosemont: American Academy of Orthopaedic Surgeons; 2013. p. 483–9.Google Scholar
  15. 15.
    Moore-Reed SD, Kibler WB, Sciascia AD, Uhl T. Preliminary development of a clinical prediction rule for treatment of patients with suspected SLAP tears. Arthroscopy. 2014;30(12):1540–9.CrossRefGoogle Scholar
  16. 16.
    Sciascia A, Cromwell R. Kinetic chain rehabilitation: a theoretical framework. Rehabil Res Pract. 2012;2012:1–9.Google Scholar
  17. 17.
    Bain GI, Galley IJ, Singh C, Carter C, Eng K. Anatomic study of the superior glenoid labrum. Clin Anat. 2013;26:367–76.CrossRefGoogle Scholar
  18. 18.
    Veeger HEJ, van der Helm FCT. Shoulder function: the perfect compromise between mobility and stability. J Biomech. 2007;40:2119–29.CrossRefGoogle Scholar
  19. 19.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.CrossRefGoogle Scholar
  20. 20.
    Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder RA. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior–posterior tears. Knee Surg Sports Traumatol Arthrosc. 2015;23:2645–50.CrossRefGoogle Scholar
  21. 21.
    Kibler WB, Sennett B, Sciascia AD. New paradigms in the throwing shoulder: pathophysiology and examination. In: Instructional course lectures, vol. 68. Rosemont: American Academy of Orthopaedic Surgeons; 2018.Google Scholar
  22. 22.
    Sciascia AD, Myers N, Kibler WB, Uhl TL. Return to pre-injury levels of play following superior labral repair in overhead athletes: a systematic review. J Athl Train. 2015;50(7):767–77.CrossRefGoogle Scholar
  23. 23.
    Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine W, et al. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med. 2010;38(7):1456–61.CrossRefGoogle Scholar
  24. 24.
    Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014;42:1155–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • W. Ben Kibler
    • 1
  1. 1.Shoulder Center of Kentucky, Lexington ClinicLexingtonUSA

Personalised recommendations