Chapter 78 - Superior Labrum Anterior to Posterior Tears and Lesions of the Proximal Biceps Tendon

Question 1

what function does the glenoid labrum and biceps tendon serve in anterior instability?

Answer 1

secondary restraint to anterior subluxation in position of apprehension (anterior band of the IGHL is primary)

Question 2

what function does the biceps tendon serve?

Answer 2

static depressor of the humeral head

Question 3

throwers mechanics that predispose to SLAP tears

Answer 3

hyper-external rotation of the humerus causes posterosuperior shift of the humerus on the glenoid (caused by contracture of the posterior band of the IGHL in abduction)

-> internal impingement of the rotator cuff on the posterosuperior labrum

Question 4

normal anatomic variants of the anterior labrum

Answer 4

1. sublabral foramen
2. cordlike MGHL plus sublabral forament
3. complete absence of the anterosuperior labrum with a cordlike MGHL - Buford complex

Question 5

how to increase diagnostic accuracy of MRI for slap tears

Answer 5

place the arm in 90degrees abduction and external rotation

can do this by having them prone, place arm overhead

Question 6

types of SLAP tears

Answer 6

I: degenerative tear with biceps anchor attached
II: biceps anchor detached from underlying glenoid
III: bucket handle no biceps involvement (biceps anchor attached)
IV: bucket handle with extension into the biceps tendon

Question 7

Treatment for SLAP tears:

Answer 7

indicated if fail extensive PT

I: debridement
II: reattachment of the detached biceps anchor to the glenoid
III: debridement of the bucket handle part
IV: biceps debridement (if <50% involvement), biceps tenotomy/tenodesis (>50% involved), and bucket handle part debridement

Question 8

outcomes of a subacromial procedure concomitant with slap repair

Answer 8

increased risk of stiffness