Skip to main content
SpringerLink
Log in

Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In the present prospective study, the functional outcomes of non-operative treatment were evaluated in patients aged between 30 and 45 years presenting SLAP lesion in diagnostic provocative tests and magnetic resonance (MR) arthrography.

Methods

Forty-six patients with a symptomatic SLAP lesion who participated in recreational level of sports were prospectively enroled. SLAP lesion was diagnosed using combinations of several clinical tests and MR arthrography findings. All patients were treated with intra-articular corticosteroid injections, followed by rotator cuff and periscapular muscle-strengthening exercises. Patients with persistent discomfort after second injection underwent arthroscopic SLAP repair. Functional outcomes were evaluated using ASES and Constant scores, and pain and satisfaction for visual analogue scale (VAS).

Results

Pain had significantly improved from 5.2 ± 2.2 to 1.0 ± 1.1 (p < 0.001) in all patients after the first corticosteroid injection. SLAP symptoms relapsed in 12 patients at an average of 2.4 months after the first injection. Symptoms were relieved in 5 of 12 patients after the second injection and strengthening exercises. The remaining seven patients underwent arthroscopic SLAP repair. Thirty-nine patients (85 %) who were treated non-operatively showed improved VAS, Constant, and ASES scores at final follow-up (p < 0.001).

Conclusions

Non-operative treatment with an appropriate regimen provided satisfactory clinical outcomes in middle-aged patients with symptomatic SLAP lesions and should be considered before recommending operative treatment.

Clinical relevance

Non-operative management using combined intra-articular corticosteroid injection with rotator cuff and periscapular strengthening exercises could be applied as primary treatment for patients with symptomatic SLAP lesion who participate in recreational level of sports.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abbot AE, Li X, Busconi BD (2009) Arthroscopic treatment of concomitant superior labral anterior posterior (SLAP) lesions and rotator cuff tears in patients over the age of 45 years. Am J Sports Med 37(7):1358–1362

    Article  PubMed  Google Scholar 

  2. Brockmeier SF, Voos JE, Williams RJ 3rd, Altchek DW, Cordasco FA, Allen AA (2009) Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 91(7):1595–1603

    Article  PubMed  PubMed Central  Google Scholar 

  3. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: Spectrum of pathology part I: Pathoanatomy and biomechanics. Arthroscopy 19(4):404–420

    Article  PubMed  Google Scholar 

  4. Chalmers PN, Trombley R, Cip J, Monson B, Forsythe B, Nicholson GP, Bush-Joseph CA, Cole BJ, Wimmer MA, Romeo AA, Verma NN (2014) Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears. Am J Sports Med 42:2825–2836

    Article  PubMed  Google Scholar 

  5. Cohen DB, Coleman S, Drakos MC et al (2006) Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack. Arthroscopy 22(2):136–142

    Article  PubMed  Google Scholar 

  6. Connolly KP, Schwartzberg RS, Reuss B, Crumbie D Jr, Homan BM (2013) Sensitivity and specificity of noncontrast magnetic resonance imaging reports in the diagnosis of type-II superior labral anterior-posterior lesions in the community setting. J Bone Joint Surg Am 95:308–313

    Article  PubMed  Google Scholar 

  7. Edwards SL, Lee JA, Bell JE et al (2010) Nonoperative treatment of superior labrum anterior posterior tears: Improvements in pain, function, and quality of life. Am J Sports Med 38(7):1456–1461

    Article  PubMed  Google Scholar 

  8. Enad JG, Gaines RJ, White SM, Kurtz CA (2007) Arthroscopic superior labrum anterior-posterior repair in military patients. J Shoulder Elbow Surg 16(3):300–305

    Article  PubMed  Google Scholar 

  9. Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM (2014) Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med 42(5):1155–1160

    Article  PubMed  Google Scholar 

  10. Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V (2008) No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50: a randomized controlled trial. Am J Sports Med 36(2):247–253

    Article  PubMed  Google Scholar 

  11. Holzapfel K, Waldt S, Bruegel M et al (2010) Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation. Eur Radiol 20:666–673

    Article  PubMed  Google Scholar 

  12. Ide J, Maeda S, Takagi K (2005) Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med 33(4):507–514

    Article  PubMed  Google Scholar 

  13. Laughlin WA, Fleisig GS, Scillia AJ, Aune KT, Cain EL Jr, Dugas JR (2014) Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair. Am J Sports Med 42(12):2837–2841

    Article  PubMed  Google Scholar 

  14. Lavelle W, Lavelle ED, Lavelle L (2007) Intra-articular injections. Anesthesiol Clin 25(4):853–862

    Article  CAS  PubMed  Google Scholar 

  15. Nakagawa S, Yoneda M, Hayashida K, Obata M, Fukushima S, Miyazaki Y (2005) Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder. Arthroscopy 21(11):1290–1295

    Article  PubMed  Google Scholar 

  16. O’Brien SJ, Allen AA, Coleman SH, Drakos MC (2002) The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy 18(4):372–377

    Article  PubMed  Google Scholar 

  17. Oh JH, Kim JY, Kim WS, Gong HS, Lee JH (2008) The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. Am J Sports Med 36(2):353–359

    Article  PubMed  Google Scholar 

  18. Oh JH, Kim SH, Kwak SH, Oh CH, Gong HS (2011) Results of concomitant rotator cuff and SLAP repair are not affected by unhealed SLAP lesion. J Shoulder Elbow Surg 20(1):138–145

    Article  PubMed  Google Scholar 

  19. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D (2013) A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med 41(4):880–886

    Article  PubMed  Google Scholar 

  20. Rhee YG, Lee DH, Lim CT (2005) Unstable isolated SLAP lesion: clinical presentation and outcome of arthroscopic fixation. Arthroscopy 21(9):1099

    Article  PubMed  Google Scholar 

  21. Sayde WM, Cohen SB, Ciccotti MG, Dodson CC (2012) Return to play after type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res 470(6):1595–1600

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schroder CP, Skare O, Gjengedal E, Uppheim G, Reikeras O, Brox JI (2012) Long-term results after SLAP repair: a 5-year follow-up study of 107 patients with comparison of patients aged over and under 40 years. Arthroscopy 28(11):1601–1607

    Article  PubMed  Google Scholar 

  23. Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder R (2015) Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc 23(9):2645–2650

    Article  PubMed  Google Scholar 

  24. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6(4):274–279

    Article  CAS  PubMed  Google Scholar 

  25. Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K (2004) Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol 182(5):1271–1278

    Article  PubMed  Google Scholar 

  26. Yung PS, Fong DT, Kong MF et al (2008) Arthroscopic repair of isolated type II superior labrum anterior-posterior lesion. Knee Surg Sports Traumatol Arthrosc 16(12):1151–1157

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ewha Shoulder Disease Center, Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea

    Sang-Jin Shin, Juyeob Lee, Yoon-Sang Jeon, Young-Won Ko & Rag-Gyu Kim

Authors
  1. Sang-Jin Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juyeob Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoon-Sang Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Young-Won Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rag-Gyu Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang-Jin Shin.

Ethics declarations

Conflict of interest

Grant sponsor: National Research Foundation of Korea (NRF); Grant Number: NRF-2013RIAIA2008601.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, SJ., Lee, J., Jeon, YS. et al. Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surg Sports Traumatol Arthrosc 25, 3296–3302 (2017). https://doi.org/10.1007/s00167-016-4226-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4226-7

Keywords

Search

Navigation