Shoulder Pain differential
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Glenoid Labrum Tear: Bankart Lesion
Glenoid Labrum Tear: SLAP Lesion
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Glenoid Labrum Tear: SLAP Lesion
What is a SLAP Lesion?
Lesion of the anterior superior labrum and the tendon of the long head of the biceps
Four types:
Type I: degenerative fraying with no detachment of biceps insertion
Type II: Most common type; Detachment of superior labrum and biceps from glenoid rim
Type III: Bucket-handle tear of labrum with an intact biceps tendon insertion to bone
Type IV: Least common type represents an intra-substance tear of biceps tendon with a bucket-handle tear of superior aspect of labrum
What is the cause?
Most common fall onto an outstretched hand (FOOSH), while the shoulder is in abduction and slight forward flexion
Fall or direct blow to the shoulder girdle
Acute traction on the arm
Abduction and ER mechanism
Signs & Symptoms:
Pain with overhead activities
Frequent catching, clicking, or popping sensation in the shoulder
Overhead athletes may develop “Dead arm” syndrome - painful shoulder with throwing resulting in no longer throwing with the same velocity
Pain referral pattern:
Pain is localized to the anterior and superior shoulder region
Diagnostic tools to rule in/out:
Most reliable special test: O’Brien’s Test
Other special tests:
Clunk test
Crank test
Anterior slide test
Biceps load
Active Compression test
MRI
Presentation of condition:
Patient presents with pain complaints during overhead activities.
Recent history of a fall or traction of the arm can result in a SLAP lesion