SLAP
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Od května do prosince 1996 jsme na naší klinice ošetrili 5 pacientů s poraněním ukotvení horního labra a ukotvení šlachy dlouhé hlavy bicepsu. Snyder označuje tato poranění termínem SLAP - superior labrum anterior posterior. Teprve rozvoj artroskopické techniky přinesl nové poznatky těchto lézí. Anamnestické Údaje a klinický obraz jsou velmi podobné impingement syndromu. 1 zde dochází k iritaci rotátorové manžety, ale příčina je intraartikulární. Teoretické práce dokazují, že poranění tohoto typu vedou ke snížení torzní rigidity ramenního kloubu, ke snížení napětí dolního glenohumerálního vazu. To spolu s chronickým přetěžováním tzv. over head aktivitou vytváří předpoklad ke vzniku mikroinstability ramena. Proto akromioplastika nevede ke zlepšení. V léčení dominuje konzervativní postup zaměřený na správné posilování ramenního pletence (především stabilizátorů lopatky), podávání non-steroid anti-inflamatory drugs (NSAID), aplikace kortikoidů intraartikulárně, fyzikální terapie, operační řešení je poslední metodou volby. Podle typu leze je doporučováno ošetřit horní labrum a šlachu bicepsu a podle stupně instability výkon doplnit stabilizací. Debridement rotátorove manžety není vždy nutný, akromioplastiku provádme tam, kde akromion má tvar II nebo III. Naše výsledky jsou předbežné. U prvních 3 pacientů došlo ke zlepšení a nyní sportují na původní úrovni. Další 2 pacienti dosud rehabilitují.
From May to December 1996 the author treated at his Clinic five patients with injuries of the anchoring of the labrum superior and anchoring of the long head of the biceps. Snyder describes these injuries as SLAP superior labrum anterior posterior. Only the development of arthroscopic technique provided new findings on these lesions. Anamnestic data and the clinical picture closely resemble the impingement syndrome. Here too irritation of the rotator cuff occurs but the cause is intraarticular. Theoretical work provides evidence that injuries of this type lead to reduction of the torsion rigidity of the shoulder joint reduced tension of the lower glenohumeral ligament. This along with chronic overburdening by so-called overhead activity creates prerequisites for the development of microinstability of the shoulder. This is why acromioplasty does not lead to improvement. As regards treatment a conservative procedure focused on correct conditioning of the brachial plexus dominates (In particular of the stabilizers of the seapula), administration of non-steroid anti-inflammatory irugs (NSAID), intraarticular corticoid administration. physical therapy, surgery is the last method of choice. Depending on the type of lesion it is recommended w treat the labrum superior and the tendon of the biceps, and depending on the degree of instability, the operation is supplemented by stabilization. Debridement of the rotator cuff is not always necessary, acromioplasty is pertormed when the acromion has shape II or III. The presented results are preliminary. In the first three patients the condition improved and at present hey pursue sports as formerly. Another two patients still have rehabilitation treatment.
PURPOSE OF THE STUDY: The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. MATERIAL AND METHODS: Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. RESULTS: A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically signifi cant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically signifi cant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). CONCLUSIONS: Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.
- MeSH
- akromion MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka MeSH
- osteoartróza * diagnostické zobrazování chirurgie MeSH
- rameno * MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions. METHODS: Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions. RESULTS: The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant. CONCLUSION: Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion.
- MeSH
- artroskopie MeSH
- horní končetina MeSH
- lidé MeSH
- poranění ramene * epidemiologie MeSH
- prevalence MeSH
- ramenní kloub * patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
... Léze SLAP 115 -- ARTROSKOPIE RAMENE -- VTRAUMATOLOGICKÉ INDIKACI 119 -- ARTROSKOPIE v v -- PŘI NESTABILITĚ ...
Druhé, rozšířené vydání 143 stran : ilustrace (převážně barevné) ; 25 cm
Publikace se zaměřuje na metody artroskopie ramenního kloubu. Určeno odborné veřejnosti.; Monografie popisuje možnosti v artroskopické operativě ramene, předkládá postupy prováděných zákroků, jejich doléčení i hodnocení.
- MeSH
- artroskopie MeSH
- poranění ramene MeSH
- ramenní kloub chirurgie MeSH
- Publikační typ
- monografie MeSH
- Konspekt
- Ortopedie. Chirurgie. Oftalmologie
- NLK Obory
- chirurgie
- ortopedie
To evaluate the efficacy of magnetic resonance (MR) examination in intra- and extra- articular shoulder disorders, in comparison with arthroscopic findings, in patients with both acute injuries and chronic problems of the shoulder. MATERIAL AND METHODS: Conventional MR images and MR arthrograms of the shoulder were obtained in 35 patients treated between January 2004 and January 2006. Each MR image was evaluated by five radiologists experienced in assessing findings on the musculoskeletal system. Subsequently, the patients underwent shoulder arthroscopy performed by shoulder arthroscopy surgeons. Each detailed arthroscopic report was compared with the pre-operative MR findings, and the sensitivity and specificity of MR examination were calculated. The arthroscopic findings served as standards of reference for comparison. RESULTS: SLAP lesions were found intra-operatively in seven out of the 35 patients (20 %). MR sensitivity was 43 % (3 to 7 patients) and specificity was 96 % (27 to 28). The accuracy of MR for SLAP lesion diagnosis was 86 % (30 of 35 patients). Tears in the anterior labrum were diagnosed by arthroscopy in 16 of 35 patients (46 %); MR sensitivity was 44 % (7 of 16 patients) and specificity was 89 % (17 of 19). The accuracy of MR for diagnosing labral tears was 68 % (24 of 35 patients). DISCUSSION: When designing our study, we tried to avoid limitations of similar investigations.We employed a nuclear magnetic resonance system with high resolution and standardized both the arthroscopic technique and the evaluation of MR images. Our results of diagnosing rotator cuff disorders and SLAP lesions are in agreement with those of other relevant studies. The limitation of our study was a small size of the group. CONCLUSIONS: Although MR imaging is a sensitive method suitable for diagnosing some shoulder disorders, the MR imaging of SLAP lesions and labral tears does not give results accurate enough to be used for pre-operative planning.
