• Clinics in Shoulder and Elbow
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• v.20 no.2
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• pp.77-83
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• 2017

Background: Although there have been multiple reports on surgical outcomes of superior labral anterior to posterior (SLAP) lesions in overhead athletes, only a few reports exist in the literature about the results of nonoperative treatment in elite (collegiate or professional) overhead athletes. To determine the clinical outcomes of nonoperative treatment of SLAP lesions in elite overhead athletes. Methods: Between January 2006 and December 2011, 69 patients were selected. Initial arthroscopic SLAP repair was performed in 19 patients and of the 50 patients who underwent nonsurgical treatment, such as range of motion gain and periscapular muscle strengthening, 14 patients were converted to surgical treatment; 5 patients were lost to follow-up. Medical records of 31 elite overhead athletes who underwent nonsurgical treatment were retrospectively reviewed. Four clinical outcome measures were used: visual analogue scale (VAS) for pain, VAS for satisfaction, American Shoulder and Elbow Surgeons (ASES) score, and subjective feeling of recovery. Results: The average follow-up period was 35.9 months (range, 24-62 months). The VAS for pain decreased from 6.5 to 2.2 (p<0.01) and VAS for satisfaction was 7.6. The ASES score increased from 54.1 to 85.9 (p<0.01). The overall average value of subjective feeling of recovery was 72%. Twenty-three out of 31 elite athletes (74.2%) returned to play after rehabilitation; these 23 athletes performed at the same or higher levels after rehabilitation. Conclusions: Nonsurgical treatment in elite overhead athletes with SLAP lesion should be considered as a treatment option.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.6 no.1
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• pp.129-139
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• 2011

Objectives : The propose of this study is to find out the clinical application of conservative treatment for SLAP lesion. Methods : We examined 2 patients with SLAP lesion who admitted Jaseng Hospital of Oriental Medicine. The patients were treated by conservative treatments including herbal mixture, acupuncture, pharmacupuncture. Results : In this study, in the end of continuous conservative treatment, patient's shoulder pain has improved. Visual Analog Score(VAS) were also decreased. Conclusions : A conservative treatment for SLAP lesion was effective in restore of functional activities, but usefulness of this treatment needs more study.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 1997.05a
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• pp.164-166
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• 1997

MR arthrography is a useful modality for evaluating the labrocapsular ligamentous complex(LOLC) of the shoulder. This study was performed to describe normal anatomic variations and pitfalis in image interpretation related to evaluation of the LOLC. MR Arthrogram of 56 shoulders in 41 asymptomatic young, active volunteers were prospectively reviewed to evaluate the labral shapes. capsular insertions and images which may mimic the lesions of glenohumoral instability. The anterior and posterior parts of the labra. respectively. varied in shape: triangular$(72\%,\; 36\%)$. round $(13\%,\; 35\%)$. cleaved$(8\%,\; 1\%)$. notched$(2\%,\; 0\%)$. flat$(5\%,\; 24\%)$ and absent$(0\%,\; 4\%)$. The anterior and posterior capsular insertions. respectively. varied in sites: Mosely and Oevergaard type I$(82\%,\;62\%)$, type II$(13\%,\; 3\%)$ and type III $(5\%,\; 2\%)$. A number of pitfalls in image interpretation were discovered. Articular cartilage undercutting the labrum$(29\%)$ and middle glenohumoral ligament in proximity to anterior labrum $(5\%)$ simulated a labral tear. Joint fluid interposed in the central. superior portion of the sublabral sulci$(25\%)$ simulated a SLAP lesion. Synovial fold$(38\%)$ in axillary pouch resembled a loose body. Knowledge of normal variations and pitfalls in MR arthrogram image interpretation of labral capsular - ligamentous complex will help the orthopedist to accurately detect debilitating derangements associated with the glenohumeral instability.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.111-116
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• 2010

Purpose: There are many known treatment modalities for spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy. However, to the author's knowledge, there is no report on the follow-up outcomes focused on remnant cysts. Materials and Methods: Six (n=6) patients with spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy, with a mean follow-up of 15 months (12-23months) following arthroscopic cyst decompression and superior labral repair, were enrolled. Residual cyst was investigated by ultrasonography and MRI. Results: Immediate postoperative ultrasonography revealed complete remission of ganglion cyst in one patient and reduced ganglion cyst size in five patients. Three-month follow-up ultrasonography showed spontaneous complete remission of the residual cysts in all patients. No recurrence on MRI was seen at one-year follow-up. Conclusion: Residual spinoglenoid ganglion cyst remaining after arthroscopic decompression and superior labral repair tends to resolve spontaneously within 3 months of surgery.

• Investigative Magnetic Resonance Imaging
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• v.18 no.3
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• pp.193-199
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• 2014

Purpose : To evaluate the relationship between superior labral dimension of the glenohumeral joint on direct MRA and presence of SLAP lesion. Materials and Methods: IRB approval was obtained and informed consent was waived for this retrospective study. Direct MRA studies of the shoulder in 296 patients (300 shoulders) with arthroscopic surgery were analyzed by two radiologists blinded to the arthroscopic results, which were used as gold standard. One of the radiologists reviewed the images twice (session 1 and 2) for the evaluation of intra-observer variability. Transverse and longitudinal dimensions of superior labrum on coronal T1-weighted images were measured as base and height of the inverted triangular-shaped superior labrum and compared between patients with SLAP lesions vs. non-SLAP patients. Presence of meniscoid labrum was noted. Statistical analysis was done using unpaired t-test. Results: Among 279 patients (283 shoulders), 122 patients (43.1%) had SLAP lesions. The mean base/height of superior labrum in SLAP and non-SLAP patients measured on T1-weighted MR image were 8.8 mm / 5.2 mm, 8.5 mm / 4.9 mm for reader 1; 8.2 mm / 4.9 mm, 8.1 mm / 4.5 mm for session 1 of reader 2; 8.0 mm / 4.8 mm, 7.6 mm / 4.3 mm for session 2 of reader 2. In SLAP group, the mean labral height was larger than non-SLAP group with statistically significant difference (p<0.05). Fifteen patients (5.3%) had meniscoid labrum according to operation records. Conclusion: In patients with SLAP lesion, the height of the superior glenoid labrum on oblique coronal image of MRA was slightly larger than non-SLAP patients. A larger height of superior glenoid labrum may be associated with SLAP lesions.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.36-42
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• 2015

Background: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. Methods: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged <40 years, and group 2 included 30 patients aged ${\geq}40years$. Functional outcome at the final follow-up was assessed using a visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons form, Constant score, University of California at Los Angeles score, and periodic change in range of motion (ROM). Anatomical outcome was evaluated using computed tomography (CT) arthrography at least 1 year after surgery. Results: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. Conclusions: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.178-178
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• 2008

In order to improve static stability and healing of reattached labrum, we combined the advantages of suture bridge and transosseous technique. Using the conventional 3 portal for anterior instability, check stability of bony Bankart and preparation of glenoid bed in 3 way including removal, reshaping or mobilization of bony fragment. Two anchors were inserted to the superior and inferior portion and medial edge of bony Bankart lesion. It usually corresponded to the area of IGHL. Medial mattress sutures were applied around IGHL complex to get enough depth of glenoid coverage using suture hook. Make 3.5mm pushlock anchor hole to the articular edge of glenoid cartilage. Proximal suture bridge was applied at first and then distal suture bridge was inserted to mobilize the labrum in proximal direction. These construction can provide more stable labral repair with wide contact and compression in case of deficient bony stability. It not only avoids technical disadvantage of point contact with anchor fixation, but also decreasing gap formation through cross compression of labrum that couldn't gain even with the transosseous fixation which affords linear compression effect. Additional bony stability could be gained if the the bony fragment was mobilized to the glenoid margin with potential healing bed or reshaped for the good contact with reattached labrum.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.175-182
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• 2007

Purpose: This study compared the SLAP lesions caused by a sports-induced injury with those caused by a non-sports-induced injury. Materials and Methods: The study was performed on 54 patients who had undergone arthroscopic surgery for a SLAP lesion. There were 21 sports-induced-injury patients (group I) and 36 non-sports-induced injury patients (group II). The mean age of the men was 36 years and that of the women was 48 years. In both groups, the frequency of a concomitant injury and the clinical outcomes at the last follow-up was evaluated using the UCLA score, Rowe score, and the ASES score. Results: According to their injury mechanism, , there were 14 cases (67%) of repeated microtrauma injury in group I and 25 cases (75%) of compression injury type in group II. As a concomitant pathology, there was 11 cases of shoulder instability and 5 cases of a rotator cuff tear in group I, and 23 cases of rotator cuff tears and 14 cases of shoulder instability in group II. At the last follow up, group I showed slightly better clinical satisfaction (P>0.05). Conclusion: The possibility of a SLAP lesion accompanying other diseases is high. Therefore, an accurate assessment of concomitant injury lesions before surgery is important for the treatment outcome.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.78-82
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• 1998

The following will describe a method of evaluating the SLAP lesion in the recurrent anterior dislocation of the shoulder. We have named it the biceps load test. The biceps load test is performed with the patient in the supine position and the arm to be examined is abducted 90/sup°/, and the forearm is in the supinated position. First, the anterior apprehension test is performed. When the patient become apprehensive, the patient is allowed active flexion of the elbow, while the examiner resists elbow flexion. If the apprehension is relieved or diminished, the test is negative. If aggravated or unchanged, the test is positive. A prospective study was performed, in which 75 patients who were diagnosed as having recurrent unilateral anterior instability of the shoulder underwent the biceps load test and arthroscopic examination. The biceps load test showed negative results in 64 of these patients, of which the superior labral-biceps complex was intact'in 63 cases and only I shoulder revealed a type n SLAP lesion. E]even patients with a positive test were confirmed to have type n SLAP lesions. A positive biceps load test represents an unstable SLAP lesion in a patient with recurrent anterior dislocation of the shoulder. The biceps load test is a reliable test for evaluating the SLAP lesion in the recurrent anterior dislocation of the shoulder(sensitivity: ,9] .7%, specificity: 100%, positive predictive value: 1.00 and negative predictive value: 0.98). Biceps contraction increases the torsional rigidity ?of the glenohumeral joint and long head of biceps tendan act as internal rotator of the shoulder in the abducted and externally rotated position. These stabilize the shoulder in abduction and external rotation position in the biceps load test.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.41-46
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• 1999

Glenoid labrum acts as one of static stabilizer of the glenohumeral joint. It deepens the glenoid socket and may also serve as a chock, acting as a wedge in preventing glenohumeral translation. Two types of variations in labral anatomy were noted by Detrisac and Johnson. Type A has a superior labrum that is detached centrally but well attached peripherally. The type B labrum is well attached centrally and peripherally at all sites. A meniscoid-type labrum is thought to be normal unless there are splits or fragmentation of the overlying labral tissue. Meniscoid type labrum is different from SLAP II lesion in that it has a firm anchoring on the superior labrum. We observed four cases that had a meniscoid variant superior labrum, which covered the superior glenoid unusually larger than normal in the arthroscopic treatment of shoulder pathology including instability and rotator cuff diseases. We did arthroscopic reshaping and debridement of meniscoid variant superior labrum combined with pathologic change of the glenohumeral joint. Further study would be required for understanding the mechanism of the development of meniscoid variant labrum and its clinical significance.