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Case 11

History:

36 year old female with shoulder pain and limited range of motion

Findings:

MRI arthrogram shows extension of contrast underneath a displaced superior glenoid labrum from anterior to posterior.

Diagnosis:

SLAP lesion

Discussion:

A SLAP tear stands for Superior Labrum, Anterior to Posterior. It was first described by Snyder in 1990. Superior labral tears can occur when a patient falls onto an outstretched hand or shoulder. They may also occur in association with rotator cuff tendonitis and tears. Oftentimes, however, the exact cause of the superior labral tear is not known. This injury has become recognized as an important cause of shoulder disability.

The Snyder classification of SLAP lesions is as follows:

  • Type I – Superior labral fraying and degenerative change without detachment of the labrum from the glenoid and without biceps tendon involvement.
  • Type II -A Type I lesion with stripping of the superior labrum with its attached biceps tendon from the superior rim of the glenoid.
  • Type III – A bucket handle tear of the superior labrum with displacement of the inferior portion of the tear into the joint while the labrum and biceps tendon remain attached to the glenoid superiorly.
  • Type IV – A bucket handle tear of the labrum with associated tear of the biceps tendon. The inferior displaced portion of the tear includes a portion of the injured biceps tendon and there is also a partial tear of the biceps tendon attached to the superior glenoid.

References:

  • Cartland JP, Crues III JV, Stauffer A, Nottage W, Ryu RKN.  MR Imaging in the Evaluation of SLAP Injuries of the Shoulder: Findings in 10 Patients. AJR 1992; 159:787-792.
  • Monu JUV, Pope TL, Chabon SJ, Vanarthos WJ. MR Diagnosis of Superior Labral Anterior Posterior (SLAP) Injuries of the Glenoid Labrum:Value of Routine Imaging Without Intraarticular Injection of Contrast Material.
    AJR 1994; 163:1425-1429.
  • Hodler J, Kursunoglu-Brahme S, Flannigan B, Snyder SJ, Karzel RP, Resnick D. Injuries of the Superior Portion of the Glenoid Labrum Involving the Insertion of the Biceps Tendon: MR Imaging Findings in Nine Cases. AJR 1992; 159:565-568.
  • Snyder SJ, et al. SLAP Lesions of the Shoulder. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 6(4):274-279, 1990.