SLAP vs Bankhart vs Hills Sachs

Question 1

SLAP Overview

Answer 1

• Superior Cabral anterior posterior tear of glenoid labrum
• Involves superior glenoid labrum, where long head of biceps tendon inserts
• Most commonly seen in falls on outstretched arm, repetitive throwing, trauma, heavy lifting, hyperextension, or shoulder abducted and slightly forward flexed at time of impact

Question 2

SLAP Clinical Presentation

Answer 2

• Intermittent pain that is associated with OH movements
• Isolated SLAP lesions are uncommon, often accompanied with other injuries
• Sensation of painful clicking or popping
• Loss of shoulder IR
• Pain with OH motions
• Inability to lie on affected shoulder
• “dead arm” shoulder

Question 3

SLAP Exam / Special Tests

Answer 3

• Pain frequently seen with passive ER at 90 degrees of shoulder abduction and loss of IR
• Compression rotation test
• O’Briens test
• Apprehension Test
• Speeds test
• Yergasons test
• Biceps load test II

Question 4

SLAP Medical Management

Answer 4

• Initial treatment is conservative (anti-inflammatory meds, cryotherapy, rest, activity modification)
• Type I tears = commonly asymptomatic and do not require treatment
• Type II tears = surgical reattachment
• Type III tears = resection of bucket handle tear

Question 5

SLAP Conservative Treatment

Answer 5

• Cessation of throwing activities
• Anti-inflammatory meds
• Reduce pain and inflammation
• Restore normal shoulder motion
• Strengthening of shoulder girdle

Question 6

SLAP Post-Op Treatment

Answer 6

• Immobilized for short period
• Week 0-3 = immobilizes in IR sling, ER contraindicated, abduction limited to 60 degrees, pendulum and elbow ROM exercises
• Week 4-8 = sling stopped, shoulder motion increased to active assistive, limited ER to 30 degrees, IR and ER ROM activities progress to 90 degrees of shoulder abduction
• Week 8 = initiate resistance exercises, scapular strengthening, approx 120 degrees of shoulder ER must be achieved before starting scapular strengthening, resisted biceps activity prohibited for 2 months
• Week 16 = sport directed throwing program can start in OH athletes
• Week 24 = contact sports

Question 7

Bankhart Lesion

Answer 7

• Injury of anterior-inferior labrum (at aspect of glenoid fossa)
• Anterior shoulder pain with ER and audible sounds with a positive crank test is indicative
• Crank Test = pain during combined compression and rotation of humerus when it is in 160 degrees of scapular plan elevation

Question 8

Hills Sachs Lesion

Answer 8

• Defect or “dent” of post-sup-lat humeral head (associated with anterior dislocation of humeral head on glenoid)
• During dislocation, once humeral head is in front of the glenoid, the post-lat surface of humeral head may strike the anterior glenoid, causing compression fracture
• Symptoms = pain in shoulder (especially with OH movements), instability in shoulder, clicking or popping sensations in shoulder, and reduced ROM