AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-SLAP Tears

Pdf Summary

This 2019 Tulane Orthopaedic Surgery presentation by Dr. Felix H. Savoie III addresses the diagnosis and management of superior labrum anterior-posterior (SLAP) lesions of the shoulder. It reviews historical perspectives, clinical exams, imaging, and surgical indications with an emphasis on when SLAP repair is appropriate.<br /><br />The superior labrum demonstrates variability in normal anatomy and often shows age-related fraying, especially in overhead athletes. Early studies (Andrews & Carson, 1985; Snyder, 1990) characterized SLAP lesions predominantly as traction injuries related to the biceps tendon, with debridement as the initial treatment. The first surgical repairs targeting unstable Type 2 lesions were reported in the early 1990s with high success rates using arthroscopic techniques.<br /><br />Key developments include Burkhart, Morgan, and Kibler’s 2003 work outlining pathomechanics in throwing athletes, including scapular dyskinesis and peel-back SLAP lesions. However, by 2019, challenges remain regarding clear surgical indications and optimal techniques. The author emphasizes that thorough clinical evaluation—detailed history with a distinct injury event and reproducible exam findings such as a modified “SLAP test”—is critical. Imaging, especially MRI or MR arthrography with the shoulder in the ABER position, aids diagnosis but cannot replace a good history and physical exam. Overreliance on MRI findings risks unnecessary surgery and poor outcomes.<br /><br />Surgical repair should be reserved for clinically unstable Type 2 lesions verified by exam. In cases with biceps tendon damage or distal biceps tendonitis, tenodesis can be considered. In overhead athletes, repair outcomes may be less favorable, and careful patient selection with integrated rehabilitation is crucial.<br /><br />The author cautions that many failed SLAP repairs stem from misdiagnosis or inadequate clinical assessment rather than surgical technique. When applied appropriately, SLAP repair achieves excellent results around 95% of the time. If instability is not demonstrable, biceps tenodesis may be preferable (except in pitchers).<br /><br />In summary, successful SLAP lesion management requires a return to fundamentals: prioritizing clinical history and exam over MRI, recognizing true instability, and tailoring surgery accordingly for the best outcomes.

Asset Caption

Dr. Felix H. "Buddy" Savoie, III, M.D.

Keywords

SLAP lesions

shoulder labrum

orthopaedic surgery

arthroscopic repair

biceps tendon injury

clinical examination

MRI arthrography

overhead athletes

Type 2 SLAP lesion

biceps tenodesis