SLAP, Biceps, or Both: How to Manage this Difficult Problem in our Overhead Athletes (AANA19)-Cases_ SLAP, Biceps, or Both_ How to Manage this Difficult Problem in our Overhead Athletes-Dr. Anthony A. Romeo, M.D.

Cases_ SLAP, Biceps, or Both_ How to Manage this Difficult Problem in our Overhead Athletes-Dr. Anthony A. Romeo, M.D.

Video Transcription

Video Summary

This discussion centers on managing shoulder injuries, particularly in overhead athletes like baseball players and swimmers, focusing on partial thickness rotator cuff disease, SLAP (Superior Labrum Anterior to Posterior) lesions, and biceps tendon pathology. Key points include the frequent use of debridement for rotator cuff tears and the complexity of the junction where the biceps tendon, labrum, and rotator cuff intersect, making diagnosis and treatment challenging.<br /><br />A recent Irish systematic review favors biceps tenodesis over SLAP repair for better rates of return to play and fewer reoperations, especially in older patients or those with significant biceps symptoms. Younger athletes with pure SLAP lesions failing conservative treatment may undergo SLAP repair, preferably knotless. In swimmers, biceps tenodesis is less common but can be effective.<br /><br />Posterior capsule release is rare and generally not recommended due to potential instability risks. Clinical exams, including the "three-pack" tests (palpation tenderness over biceps tendon, positive active compression, and resisted throwing motion inducing pain), help distinguish biceps involvement.<br /><br />Case discussion highlights a professional baseball outfielder with SLAP and rotator cuff pathology treated successfully with debridement, labral repair, and biceps tenodesis, resulting in significant pain relief and extended playing ability. Emphasis is on individualized treatment balancing labral repair, biceps surgery, and rotator cuff management based on clinical findings and imaging, aiming to optimize outcomes while minimizing complications.

Asset Caption

Instructional Course Lecture: SLAP, Biceps, or Both: How to Manage this Difficult Problem in our Overhead Athletes

Keywords

shoulder injuries

overhead athletes

rotator cuff disease

SLAP lesions

biceps tendon pathology

biceps tenodesis

shoulder surgery outcomes