I went to two regular doctors for a shoulder problem that no one could figure out. Several tests were positive for a labral tear. Others were negative. It wasn't until I went to a third (orthopedic surgeon) and had an arthroscopic exam that a SLAP tear was diagnosed. Is this typical or was my case unusual?
SLAP stands for superior labral anterior posterior and refers to an injury of the labrum in the shoulder. The labrum is a dense ring of fibrocartilaginous tissue attached to the outer rim of the shoulder socket. SLAP injuries of the labrum are most common with overhead athletes. But they can occur with age and degeneration.
There are over two dozen clinical tests possible for the examination of the shoulder. Not all of these test specifically for SLAP lesions but many do. Not all tests for SLAP lesions are positive even when there is a tear. That's because there are four types of SLAP tears based on the severity of the damage. Some tests work better for mild lesions. Others are more accurate for severe tears.
A recent review of clinical tests for SLAP lesions looked at studies done over a 10-year period of time. Validity, reliability, and accuracy of each test were carefully studied. There was no single test accurate enough to identify the presence or absence of a SLAP injury.
Arthroscopic exam does seem to be the most accurate. The surgeon can insert a long, thin needle into the shoulder joint. There's a tiny TV camera on the end that broadcasts on a viewing screen a picture of what's going on inside the joint. This is really the most accurate diagnostic test possible.
Wayne A. Dessaur, MSc, and Mary E. Magarey, PhD. Diagnostic Accuracy of Clinical Tests for Superior Labral Anterior Posterior Lesions: A Systematic Review. In Journal of Orthopaedic & Sports Physical Therapy. June 2008. Vol. 38. No. 6. Pp. 341-352.
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