IC 301-2024: Down with the SLAP: A Case-Based Approach to Biceps, Labral and Shoulder Dysfunction-IC 301: Down with the SLAP: A Case-Based Approach to Biceps, Labral and Shoulder Dysfunction

Video Transcription

Video Summary

The session discusses interactive approaches to addressing shoulder issues, specifically focusing on Superior Labrum Anterior to Posterior (SLAP) lesions. These are not exclusive diagnoses but part of more extensive, misunderstood problems. Experts highlight the importance of understanding shoulder mechanics, pathology, and appropriate terminology. <br /><br />Dr. Jeff Grantham presents a case of a 32-year-old male with shoulder pain following a bike injury. Despite prior SLAP repair, he had ongoing discomfort and difficulty with overhead activities. Examination reveals painful abduction and positive dynamic labral shear (DLS) tests. MRI shows a cleft in the posterior labrum. Jeff discusses the rationale behind getting MRIs and arthrograms, based on patient's symptoms and previous surgeries. The MRI shows posterior labrum issues, confirmed by arthroscopy. After discussing with peers, it is decided not to simply debride but to repair the posterior labrum while avoiding over-constraining the biceps. This approach helped the patient regain full range of motion and relieved his pain.<br /><br />Dr. Grantham emphasizes that adequate understanding of shoulder biomechanics and proper postoperative therapy focusing on scapular stabilization are crucial. A 23-year-old softball pitcher’s case is discussed to underscore the importance of precise physical therapy and further diagnostics when standard MRI does not clearly reveal posterior labral issues.<br /><br />The team debates over choosing conservative treatment versus surgical interventions and maintaining appropriate patient expectations. Lateral position is preferred for better visualization during surgery. Specific tests and modified physical examinations are advocated to identify underlying labral pathology, especially in athletes with tightness or pain.<br /><br />Post-discussion consensus conveys the dynamic role of the superior labrum and the necessity of personalized management plans over a one-size-fits-all approach. The overarching aim is to ensure patients return to normal function while minimizing unnecessary surgical interventions, especially in athletes.

Keywords

shoulder issues

SLAP lesions

shoulder mechanics

shoulder pathology

shoulder terminology

shoulder pain

bike injury

labral shear tests

MRI

arthroscopy

scapular stabilization

physical therapy

surgical interventions