Anterior Shoulder Instability with Type IX Superior Labral Anterior to Posterior (SLAP) Lesion–about a Clinical Case| Stephy Publishers

 


SOJ Orthopaedics and Rehabilitation - (SOJOR)| Stephy Publishers

Abstract

Lesions of the superior labrum anterior to posterior (SLAP) are often associated with repetitive movements of the shoulder above the head or traumatic history. Types V to X lesions are much rarer, and their prevalence has not yet been described in the literature. In this regard, we report the clinical case of a 34-year-old man, who reported multiple episodes of anterior dislocation of the right shoulder, which he reduced on its own. The patient described onset of instability after a fall with the upper limb in extension and abduction, 2 years before presentation to the authors. An arthro-magnetic resonance was performed that showed a rupture of the upper labrum that extending through the anterior to posterior region reaching the lower edge of the glenoid, with damage to the cartilage at the anterior portion of the glenoid. Surgical treatment was proposed, with diagnostic arthroscopy and arthroscopic suture of the labrum using anchors. Four years after surgery, the patients presented with no pain complaints, without new episodes of dislocation. At physical examination, he presented a symmetrical range of motion, negative apprehension tests and negative rotator cuff strength tests. In the assessment of symptoms on the DASH scale, pre-surgery the patient obtained a score of 39.2, and four years later scored 1.6. In summary, although rare, extensive SLAP lesions are cause of significant morbidity for the patient and cause of accelerated degeneration of the glenohumeral joint, so surgical treatment, preferably arthroscopic, is recommended, with good clinical results.

Keywords

Instability, SLAP lesion, Labrum

Introduction

Superior labral anterior to posterior (SLAP) lesions have two incidence peaks: in young people between 20-30 years old and in adults between 40-50 years old. In the first group, they occur mainly after trauma, while in the second, due to degenerative causes, mainly associated with repetitive movements of the shoulder above head.1 Shoulder pain is the most frequent complaint worst in movements at height, as well as sensation of blockage or shoulder bounce. On physical examination, pain on palpation of the rotator interval supports the diagnosis. The most common positive findings are related to shoulder instability: anterior drawer (53%), apprehension test at 90º abduction and external rotation (86%) and relocation test (86%).2

SLAP lesions were initially described and classified by Snyder as:2

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