Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability

• Published in: Journal of shoulder and elbow surgery Vol. 29; no. 1; pp. 95 - 103
• Main Author: Kandeel, Amr Abdel-Mordy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2020
• Subjects: Adolescent; Adult; Arthroscopy; Bankart lesion; Bankart Lesions - complications; Bankart Lesions - diagnosis; Case-Control Studies; diagnosis of SLAP lesion; diagnostic accuracy; Female; Humans; Joint Instability - etiology; Male; Physical Examination - methods; predictive value; Predictive Value of Tests; Prospective Studies; provocative tests for SLAP lesion; Recurrence; Recurrent anterior glenohumeral instability; Shoulder Joint - injuries; type II SLAP lesion; type V SLAP lesion; Young Adult; type II SLAP lesion; Level IV; diagnostic accuracy; predictive value; Diagnostic Study; Recurrent anterior glenohumeral instability; type V SLAP lesion; diagnosis of SLAP lesion; Bankart lesion; Case-Control Design; provocative tests for SLAP lesion
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2019.05.038

The literature has reported debatable diagnostic accuracy of clinical provocative tests for a type II superior labral anteroposterior (SLAP) lesion, especially in the context of a type V SLAP (concurrent Bankart and type II SLAP) lesion. This study was conducted to determine whether the investigated provocative tests offer reliable predictive values in the diagnosis of type II SLAP lesions in patients with recurrent anterior glenohumeral (GH) instability.
This prospective case-control study carried out between September 2014 and September 2018 included 51 patients with post-traumatic recurrent anterior GH instability. Patients were prospectively evaluated for type II SLAP lesions by 9 provocative tests: Jobe relocation test, abduction–external rotation test, anterior slide test, biceps load test I, biceps load test II, pain provocation test, labral tension test, crank test, and the O'Driscoll dynamic labral shear test. The results of these tests were compared with findings of diagnostic arthroscopic GH examinations (control).
Statistical analysis revealed the mean age of the studied group to be 26.1 ± 7.56 years, with male predominance (50 patients; 98.04%). Arthroscopic examination revealed a Bankart lesion in isolation and in association with a type II SLAP lesion (ie, a type V SLAP lesion) in 15 (29.4%) and 36 (70.6%) patients, respectively. The anterior slide test yielded the highest positive and lowest negative likelihood ratios (2.91 and 0.52, respectively).
Except for the anterior slide test, which can be validated for the clinical diagnosis of type II SLAP lesions in patients with traumatic recurrent anterior GH instability, the investigated tests offer poor predictive values and should be cautiously used in clinical practice.