SLA{ TEARS

Question 1

SLAP tears in throwers may be due to:

Answer 1

posterior band of IGHL Tightness

- shifts glenohumeral contact point posterosuperiorly and increases shear force on the superior labrum

Question 2

How does SLAP comopromise shoulder stability?

Answer 2

increases strain on the anterior band of IGHL

Question 3

Tuoheti classification:

Answer 3

this is how the biceps attaches to the glenoid
Types I and II are posterior and predominantly posterior
- accounts for >70% of natural morphology

“posterior to the 12 o’clock position”

Question 4

poorest area of labral blood supply?

Answer 4

anterior-superior labrum

• it doesn’t heal
• anchors the biceps tendon

Question 5

clinical relevance of a sublabral recess:

Answer 5

can be confused with a tear on MRI

Question 6

What is a Buford Complex

Answer 6

cordlike MGHL with associated bare area of the anterosuperior labrum

Question 7

SLAP CLassification:

Snyder = original, modified by Maffet

Answer 7

I: labral fraying, intact anchor
II: labral fraying with detached biceps anchor
III: labral buckethandle tear with intact anchor
IV: labral tear with detached biceps tendon anchor
V: type II + Bankart

Question 8

what are physical exam signs for SLAP tear:

Answer 8

O'Brien's
"crank test"
Job relocation test
posterior load and shift
 - apprehension tests are typically positive

Question 9

if patient has a labral tear AND infraspinatus atrophy check for:

Answer 9

a paralabral ganglion cyst within the spinoglenoid notch

Question 10

Peelback test

Answer 10

shows peelback of the labrum with 90 deg ER and abduction

Question 11

What are the characteristics of “failed slap syndrome”

Answer 11

after trying to fix the anchor, you get persistent pain and limitation of post-operative ROM

Question 12

can the proximal biceps tendon be a pain generator?

Answer 12

yes, it is highly innervated, and may be a cause of failed slap syndrome

Question 13

what is the most likely treatment for failed SLAP syndrome?

Answer 13

• if age >30 with biceps pathology and concern for cosmesis, to LHB tenodesis
• if older, obese, poor biceps tendon quality do a LBH tenotomy

Question 14

HOw do people do with revision arthroscopic slap repair?

Answer 14

Park et al demonstrated inferior outcomes, low satisfaction, low ASES score, low return to work and low return to sport

Question 15

Suprascapular nerve risk during SLAP anchor placement

Answer 15

• as high as 17% of complications of SLAP surgeries are nerve injuries
• at risk with medial breach of the glenoid neck
• breaches occur with the use of the anterosuperior portal and the rotator interval portal
• the suprascapular nerve is in closer proximity to the breach when using the rotator interval portal to place an anchor on the posterosuperior aspect of the glenoid rim

Question 16

what pitching position puts the labrum at highest risk?

Answer 16

late cocking

• puts a posterior vector on the superior labrum
• Shepard et al. demonstrated the labrum is weakest with a posterior vector.