Abstract
Occurrence of the SLAP injury with respect to the time of playing season is an important factor to discuss with the athlete. In the majority of cases, management should begin with nonoperative treatment – including initial rest with focused rehabilitation of the involved shoulder, correction of all kinetic chain deficits, and then a progressive short toss/long toss/mound program. If the athlete has persistent or recurrent symptoms that prevent return to activities, then operative treatment is necessary. The operative treatment should include (1) debridement of all nonviable tissue underlying the superior and posterosuperior labrum; (2) preparation of the adjacent glenoid rim to provide a biologic surface for healing; (3) placement of secure, low-profile anchors for stable labral fixation; and (4) treatment of all concomitant pathology. A well-structured, precise rehabilitation protocol followed by a closely supervised tossing/mound program is essential for optimal outcome.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19:404–20.
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy. 2003;19:531–9.
Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641–61.
Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med. 2006;34:1643–7.
Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44:300–5.
O’Brien SJ, Pagnani MJ, Fealy S, et al. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–3.
Ben Kibler W, Sciascia AD, Hester P, et al. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37:1840–7.
Bennett WF. Specificity of the speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14:789–96.
Yergason RM. Supination sign. JBJS. 1931;13:160.
Chronopoulos E, Kim TK, Park HB, et al. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med. 2004;32:655–61.
Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19:517–23.
Bigliani LU, Codd TP, Connor PM, et al. Shoulder motion and laxity in the professional baseball player. Am J Sports Med. 1997;25:609–13.
Ajuied A, McGarvey CP, Harb Z, et al. Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2018;138:699–709.
Borrero CG, Casagranda BU, Towers JD, et al. Magnetic resonance appearance of posterosuperior labral peel back during humeral abduction and external rotation. Skelet Radiol. 2010;39:19–26.
Sasaki T, Saito Y, Yodono H, et al. Labral-ligamentous complex of the shoulder. Evaluation with double oblique axial MR arthrography. Acta Radiol Stockh Swed 1987. 2003;44:435–9.
Ciccotti M, Ciccotti M. Surgical repair technique for a type II SLAP tear. In: Disorders of the rotator cuff and biceps tendon. Atlanta, New York, Philadelphia: Elsevier; 2019. In press.
Morgan CD, Burkhart SS, Palmeri M, et al. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14:553–65.
Edwards SL, Lee JA, Bell J-E, et al. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med. 2010;38:1456–61.
Fedoriw WW, Ramkumar P, McCulloch PC, et al. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014;42:1155–60.
Cohen DB, Coleman S, Drakos MC, et al. Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack. Arthroscopy. 2006;22:136–42.
Kaar TK, Schenck RCJ, Wirth MA, et al. Complications of metallic suture anchors in shoulder surgery: a report of 8 cases. Arthroscopy. 2001;17:31–7.
Sassmannshausen G, Sukay M, Mair SD. Broken or dislodged poly-L-lactic acid bioabsorbable tacks in patients after SLAP lesion surgery. Arthroscopy. 2006;22:615–9.
Katz LM, Hsu S, Miller SL, et al. Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy. 2009;25:849–55.
Laughlin WA, Fleisig GS, Scillia AJ, et al. Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair. Am J Sports Med. 2014;42:2837–41.
Chalmers PN, Trombley R, Cip J, et al. Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears. Am J Sports Med. 2014;42:2825–36.
Stetson WB, Templin K. The crank test, the O’Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. Am J Sports Med. 2002;30:806–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ciccotti, M.C., Ciccotti, M.G. (2019). A 19-Year-Old Thrower with an In-Season Shoulder Injury. In: Kibler, W., Sciascia, A. (eds) Mechanics, Pathomechanics and Injury in the Overhead Athlete. Springer, Cham. https://doi.org/10.1007/978-3-030-12775-6_18
Download citation
DOI: https://doi.org/10.1007/978-3-030-12775-6_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-12774-9
Online ISBN: 978-3-030-12775-6
eBook Packages: MedicineMedicine (R0)