Differentiation of SLAP Lesions

Pitchers are frequently seen in orthopedic clinics for injuries to their throwing shoulder. Many of these pitchers complain of a “dead arm” or a severe decrease in the velocity at which they can pitch. It is extremely important as direct access practitioners that we correctly diagnose these injuries, especially in the presence of a Superior Labral Anterior Posterior tear (SLAP) lesion. SLAP injuries frequently present with concurrent pathologies that may mask the classic signs of the SLAP. Failure to properly diagnose these pathologies may lead to further disability for the pitcher.

There are four tests and proceedures that are commonly used to diagnose shoulder impairments, in particular SLAP lesions. These include Bicipital groove tenderness, O’Brien’s Cross Arm test, Speeds Test, and Modified Jobe Relocation Test. The O’Brien’s and Speed’s test are considered highly specific for anterior Type II SLAP lesions. The Modified Jobe Relocation Test is considered highly specific for posterior Type II SLAP lesions which is the most common SLAP lesion in pitchers.

During arthoscopic surgery on pitcher’s (+) for a posterior Type II SLAP lesion, placing the shoulder in the initial position for the Modified Jobe Relocation test resulted in a (+) peel back sign with subluxation of the posterior superior labrum. During the second portion of the test, a posterior directed force is applied to the proximal humerus which puts the biceps tendon on traction and reduces the labrum to a normal position. Given this information, the Modified Jobe Relocation Test should be performed on every pitcher that presents to the clinic with c/o “dead arm” to determine whether a posterior Type II SLAP lesion is present.

Reference:

Burkhart, Stephan. “The Disabled Throwing Shoulder: Spectrum of Pathology Part II: Evaluation and Treatment of SLAP lesions in Throwers.” Arthroscopy: The Journal of Arthroscopic and Related Surgery 19.5 (2003): 530-539. Web. 21 Oct 2010.

Adrienne Zeiler