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Tears of the Glenoid Labrum / SLAP Lesion / Bankart Lesion
Definition: The glenoid labrum is a fibrocartilagenous rim attatched to the circumference of the glenoid fossa. A glenoid tear denotes a brake in the continuity of the aforementioned structure. A SLAP lesion is an initialism for "superior labral tear from anterior to posterior", and this type of tear occurs at the insertion of the long head of biceps brachii where it attaches to the supra-glenoid tubercle. In orthopaedic terms, a Bankart lesion is a tear of the anterior glenoid labrum due to repeated (anterior) shoulder dislocations.
Causes: SLAP lesions are primarily associated with throwing activities. Other causes of labral tears include falling onto an outstretched hand with the involved limb held close to the body, or direct falls onto the shoulder.
Repetitive heavy lifting can be a contributing factor to the development of glenoid labrum tears.
Bankart lesions are the result of repeated (anterior) shoulder dislocations.
Examination: There are numerous symptoms associated with glenoid labrum tears. Patients will commonly present with a dull ache over the affected shoulder joint. This can be aggravated by exertive or simple movements. Patients suffering from glenoid labrum tears often report some discomfort when lying on the affected shoulder, and overhead throwing activities may produce a catching feeling during a specific phase of their swing.
Orthopaedic tests for glenoid labrum tears:
Glenoid compression test: with the patient seated, the practitioner abducts the patient's symptomatic arm to 90° than applies a compressive force through the humerus while rotating it internally and externally. The reproduction of a click or popping sound with or without pain indicates a positive.
Active glenoid compression test: this test is specific to SLAP lesions. With the patient standing and the symptomatic arm abducted to 90°, fully adducted, and the forearm pronated, the patient actively resists the examiner's downward force about the patients arm. The test is than repeated with the patient's forearm supinated. Pain and/or click inside the shoulder joint during the supinated phase of the examination points to a SLAP lesion, pain in the pronated phase of the test indicates an acromio-clavicular pathology.