AANA Lab Course 912 - Arthroscopic Shoulder Solutions-SLAP and Biceps Case Presentations_ Traumatic SLAP Lesion in Non-throwing Athlete, SLAP Tear in the Throwing Athlete, Biceps Tenodesis_Tenotomy All Master Faculty; Moderator

SLAP and Biceps Case Presentations_ Traumatic SLAP Lesion in Non-throwing Athlete, SLAP Tear in the Throwing Athlete, Biceps Tenodesis_Tenotomy All Master Faculty; Moderator_ Larry D. Field, M.D.

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Pdf Summary

The document presents multiple clinical cases focusing on the diagnosis and treatment of shoulder pathologies involving SLAP (Superior Labrum Anterior-Posterior) lesions and biceps tendon issues. It illustrates the complexity in distinguishing biceps and labral pathology through history, physical exams, imaging (MRI/MRA), and response to treatments such as corticosteroid injections and physical therapy.<br /><br />Case examples highlight patients ranging from laborers and mechanics with anterior shoulder pain and negative instability symptoms, to athletes like pitchers with posterior shoulder pain and specific SLAP findings. Common clinical features include pain localized to the biceps groove, positive impingement signs, and sometimes weakness or catching sensations. Diagnostic challenges arise due to overlapping symptoms of rotator cuff, biceps, and labral involvement.<br /><br />Treatment approaches vary: initial nonoperative management with physical therapy and injections is typical, but recurring symptoms prompt further imaging and possible diagnostic arthroscopy. Surgical options discussed include biceps tendon debridement, tenotomy, tenodesis (arthroscopic suprapectoral vs. open subpectoral techniques), SLAP repair, or isolated rotator cuff repair.<br /><br />The document underscores the risks and complications linked to open subpectoral tenodesis, such as deep infections, humeral fractures, and nerve injuries, favoring arthroscopic suprapectoral approaches with transverse humeral ligament release ("slit technique") for better visualization and lower revision rates.<br /><br />Clinical decision-making requires careful analysis of patient history (acute injury vs. overuse), physical examination findings, imaging interpretations, and patient demographics. SLAP repairs are selectively recommended for “good” lesions, particularly in young male athletes with acute injuries and no significant biceps tendon pathology. Conversely, complex chronic or degenerative cases with biceps involvement might benefit more from tenodesis or tenotomy instead of repair.<br /><br />Overall, the cases and discussion emphasize individualized management strategies for SLAP and biceps tendon disorders, advocating for a combination of clinical evaluation, judicious imaging, conservative therapy, and selective surgical intervention to optimize functional outcomes.

Keywords

SLAP lesions

biceps tendon pathology

shoulder pain diagnosis

physical therapy for shoulder

corticosteroid injections

arthroscopic suprapectoral tenodesis

open subpectoral tenodesis complications

shoulder MRI and MRA

rotator cuff repair

clinical decision-making in shoulder disorders