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The glenoid labrum is one structure that provides more shoulder stability by adding 50 percent more depth to the glenoid fossa. There are many ways a SLAP lesion can occur, but the most common cause is falling onto an outstretched hand.
Overhead throwing athletes, such as pitchers and quarterbacks, are also susceptible to developing SLAP lesions due to the repetitive loads placed on the long head of the biceps tendon. Common symptoms associated with a SLAP lesion include pain with overhead activities and sensations of catching, locking, popping, or grinding within the shoulder. A Type I lesion involves degenerative fraying of the labrum with the biceps tendon remaining intact. Depending on the severity of your symptoms and dysfunction, your physician may recommend a conservative course of treatment through physical therapy.
Regardless of your course of treatment, our licensed physical therapists are experienced in treating non-operative and post-operative SLAP lesions.
History: A 50-year-old man initially presented for an MR arthrogram of his right shoulder due to pain and difficulty lifting his arm to chest level (Figs. Special shoulder problems in the throwing athlete: pathology, diagnosis, and nonoperative management.
Superior labrum, anterior-posterior lesions and biceps injuries: diagnostic and treatment considerations. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. Reliability and diagnostic accuracy of history and physical examination for diagnosing glenoid labral tears.
Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. The effect of the local corticosteroids on the healing and biomechanical properties of the partially injured tendon. Local corticosteroid injection in sport: review of literature and guidelines for treatment. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder.
Use of ultrasonographic guidance in interventional musculoskeletal procedures: a review from a single institution.
Our therapists are licensed in New York State and active members in the American Physical Therapy Association. Physical Therapist and owner Karena Wu is a graduate of the Program in Physical Therapy at Columbia University and is affiliated with several healthcare organizations in New York City.
ActiveCare accepts Medicare, No-Fault and Workers’ Compensation patients depending on schedule availability.
ActiveCare’s administrators provide seamless and efficient concierge-style client service to all of our patients. The rotator cuff is a muscle group in the shoulder that is responsible for rotation and stabilization in the glenohumeral GH joint.
A tear in the rotator cuff typically refers to a muscle or tendon tear (mild, moderate, severe) that limits ability of the arm motion, good biomechanics in the GH joint and rotation and stabilization. External Rotation: rotating the back of the hand away from the body while the elbow stays tucked in at your side.
Full Cans: lifting the arm up sideways slightly in front of the body, leading with the thumb. Sleeper Stretch: Lie on the affected side with the arm out at 90 degrees (shoulder height).
The labrum is a ring of cartilage that surrounds the outside of the glenoid fossa and allows for greater contact of the joint surfaces. It occurs both anterior to (in front of) and posterior to (behind) the site where the long head of the biceps tendon attaches to the labrum.
A sudden pulling force, such as grabbing an object in an attempt to stop a fall, is also common mechanism of injury.
These forces can eventually cause the labrum to pull away from the glenoid fossa and can sometimes tear the biceps tendon as well.
A Type II lesion involves detachment of the labrum as well as the biceps tendon from the superior glenoid. A plan of care addressing any underlying deficits in strength, stability, and motion will be used to help you return to your prior level of function. Biceps tendinosis is caused by degeneration of the tendon from athletics requiring overhead motion or from the normal aging process. Inflammation of the biceps tendon within the intertubercular (bicipital) groove is called primary biceps tendinitis, which occurs in 5 percent of patients with biceps tendinitis.1 The 95 percent of patients without primary biceps tendinitis usually have an accompanying rotator cuff tear or a tear of the superior labrum anterior to posterior, known as a SLAP lesion.


The proximal portion of the long head of the biceps tendon is extrasynovial but intra-articular.5 The tendon travels obliquely inside the shoulder joint, across the humeral head anteriorly, and exits the joint within the bicipital groove of the humeral head beneath the transverse humeral ligament. The pain is usually localized to the bicipital groove and may radiate toward the insertion of the deltoid muscle, or down to the hand in a radial distribution.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. We network with a team of physicians, chiropractors, acupuncturists and massage therapists in order to provide guidance to other modalities that may be effective in the patients’ care.
She is certified as a Strength and Conditioning Specialist, Kinesio Taping Practitioner and Pilates Instructor, and uses SpiderTech Taping. We accept all insurance with out-of-network benefits and file for most major insurance plans. And the whole ActiveCare team makes sure your time with us is a beneficial, productive and enjoyable experience.
It consists of the supraspinatus, infraspinatus, teres minor and subscapularis or SITS muscles. The socket is called the glenoid fossa and is located on the outer part of your scapula (shoulder blade).
The long head of the biceps tendon, which attaches to the superior (top) portion of the labrum, acts as another stabilizer of the glenohumeral joint.
The term SLAP lesion is defined based on the location of the tear (Superior Labrum Anterior to Posterior). Other traumatic causes include motor vehicle accidents, shoulder dislocations, and falling directly onto the shoulder. A Type III lesion produces a bucket-handle tear of the labrum but leaves the remaining portions of the labrum and the biceps tendon intact. A surgical approach may be taken with more significant injuries or if conservative treatment is unsuccessful. Spontaneous resolution of a spinoglenoid notch cyst and associated suprascapular nerve palsy: a case report. Inflam-mation of the biceps tendon in the bicipital groove, which is known as primary biceps tendinitis, occurs in 5 percent of patients with biceps tendinitis. Pathology of the biceps tendon is most often found in patients 18 to 35 years of age who are involved in sports, including throwing and contact sports, swimming, gymnastics, and martial arts. The bicipital groove is defined by the greater tuberosity (lateral) and the lesser tuberosity (medial).
This makes it difficult to distinguish from pain that is secondary to impingement or tendinitis of the rotator cuff, or cervical disk disease.14 Pain from biceps tendinitis usually worsens at night, especially if the patient sleeps on the affected shoulder.
The goal of stretching is to regain a balanced range of motion without stiffness or pain in any position.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. We work with all prospective patients to create workable payment plans regardless of insurance coverage. Use the other hand to hold the back of the affected wrist and rotate the hand down toward the floor without moving the elbow.
The glenoid fossa is a relatively flat surface that only covers a portion of the humeral head. A Type IV lesion is similar to a type III but the labral tear extends into the biceps tendon.
Depending on the type of SLAP lesion, the damaged tissue may be debrided, removed, or anchored in place with sutures. Biceps tendinitis and tendinosis are commonly accompanied by rotator cuff tears or SLAP (superior labrum anterior to posterior) lesions.
These patients often have secondary impingement of the biceps tendon, which may be caused by scapular instability, shoulder ligamentous instability, anterior capsule laxity, or posterior capsule tightness. The biceps tendon is contained in the rotator interval, a triangular area between the subscapularis and supraspinatus tendons at the shoulder (Figure 1). The stretching program should include the hamstrings and low back as well.3 A subtle loss of motion in the low back and hamstrings may lead to a major imbalance of the shoulder-stabilizing ligaments and the scapula. This type of articulation allows for a lot of motion but sacrifices shoulder stability at the same time. Patients with biceps tendinitis or tendinosis usually complain of a deep, throbbing ache in the anterior shoulder. If the biceps has ruptured, patients will describe an audible, painful popping, followed by relief of symptoms. Therefore, there are many mechanisms that must provide additional support to the glenohumeral joint.


The anterior shoulder may be bruised, with a bulge visible above the elbow as the muscle retracts distally from the rupture point.
Structures causing primary and secondary impingement may be removed, and the biceps tendon may be repaired if necessary.
The most common isolated clinical finding in biceps tendinitis is bicipital groove point tenderness with the arm in 10 degrees of internal rotation.
Risk factors of biceps rupture include a history of rotator cuff tear, recurrent tendinitis, contralateral biceps tendon rupture, rheumatoid arthritis, age older than 40 years, and poor conditioning.9 If a patient has a feeling of popping, catching, or locking in the shoulder, a SLAP lesion may be present.
Local anesthetic injections into the biceps tendon sheath may be therapeutic and diagnostic. Association of glenoid labral cysts with labral tears and glenohumeral instability: Radiological findings and clinical significance. Ultrasonography is preferred for visualizing the overall tendon, whereas magnetic resonance imaging or computed tomography arthrography is preferred for visualizing the intraarticular tendon and related pathology. When the arm is in this position, the humeral head with the bicipital groove faces forward. Conservative management of biceps tendinitis consists of rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the biceps tendon sheath. External rotation of the arm and humeral head places the tender bicipital groove in a posterolateral position. Surgery should be considered if conservative measures fail after three months, or if there is severe damage to the biceps tendon.
The Yergason test requires the patient to place the arm at his or her side with the elbow flexed at 90 degrees, and supinate against resistance18 (Figure 2).
The Neer test involves internal rotation of the arm while in the forward flexed position16 (Figure 3).
Suprascapular nerve neuropathy secondary to spinoglenoid notch ganglion cyst: Case reports and review of literature. During the Hawkins test, the patient flexes the elbow to 90 degrees while the physician elevates the patient's shoulder to 90 degrees and places the forearm in a neutral position19 (Figure 4). For the Speed test, the patient tries to flex the shoulder against resistance with the elbow extended and the forearm supinated9,20 (Figure 5).
With the patient in a hands-on-hips position, the scapula and clavicle are stabilized by one of the examiner's hands while the other hand is used to apply anterior-superior force at the elbow of the affected side.
Interactive magnetic resonance image-guided aspiration therapy of a glenoid labral cyst: A case report. Tashjian RZ, Burks RT.Arthroscopic aspiration and labral repair for treatment of spinoglenoid notch cysts. Combined intra- and extra-articular arthroscopic treatment of entrapment neuropathy of the infraspinatus branches of the suprascapular nerve caused by a periglenoidal ganglion cyst.
Sterilize the injection area and use the thumb to palpate the point that is most painful over the bicipital groove. Confirm this is the biceps tendon by externally rotating the arm and placing the elbow in 90 degrees of flexion. Insert the 10-mL syringe of 1% lidocaine plus sodium bicarbonate with the 21- or 22-gauge 1.5-inch needle subcutaneously parallel to the bicipital groove. Inject approximately 5 mL of lidocaine plus sodium bicarbonate around the biceps tendon sheath in a fan-like distribution after aspirating and checking to avoid blood vessels.
If a corticosteroid injection is required, use a hemostat between the needle and skin to hold the needle in place while changing to the 1- or 3-mL syringe containing the corticosteroid solution.5. After the corticosteroid solution is injected, remove the syringe and reattach the 10-mL syringe with lidocaine and sodium bicarbonate. This will flush any remaining corticosteroid solution out of the needle, lessening the chance that any remaining solution might cause skin atrophy or depigmentation. An alternative technique is to combine the lidocaine with sodium bicarbonate and corticosteroid solution in the same syringe to avoid changing syringes.6. A patient may also report pain relief if there is instability or subluxation of the biceps tendon.
Negative results on radiography should be followed by ultrasonography of the shoulder, which is the best method by which to extra-articularly visualize the biceps tendon.



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