Superior Labrum Anterior to Posterior Tears and Proximal Biceps Pathology

Introduction

Superior glenoid labrum tears were initially described by Andrews et al. in 1985 in a series of overhead athletes. This injury was further defined by Snyder et al. 5 years later with the terminology as it is known today, superior labrum anterior to posterior (SLAP) tear. The initial classification system was defined at that time, and has since been expanded. The diagnosis and treatment of SLAP tears has increased in recent years. Newer studies have called into question the best management of these lesions, and today controversy exists. SLAP repair, biceps tenodesis, and biceps tenotomy have been proposed as treatment options, and with each comes a unique set of issues and potential complications. Lesions of the long head of the biceps tendon, in isolation from the superior labrum pathology, can also present significant pathology, including tendinopathy, partial tears, or instability in the bicipital groove. These can also be managed surgically with biceps tenotomy or tenodesis.

Many challenges exist in the diagnosis, decision making, and management related to postoperative complications. Patient selection is of great importance in deciding on the treatment options of SLAP repair, biceps tenotomy, or biceps tenodesis. Initial nonoperative management remains the standard for most cases. Intraoperative fixation techniques and concomitant injuries provide another set of issues to consider. Monitoring for postoperative complications, including pain, stiffness, failure of SLAP repair healing, biceps cramping or fatigue, infection, bicipital groove pain, and humerus fracture, is essential. Surgeons must be prepared for and capable of managing these complications.

The purpose of this chapter is to review preoperative, intraoperative, and postoperative issues in the surgical management of superior labrum and proximal biceps pathology. The potential complications will be thoroughly discussed, as well as the appropriate management of those complications. The current literature will be presented to provide an evidenced-based treatment approach.