RESUMO
BACKGROUND: Superior labrum anterior to posterior (SLAP) lesions are targeted on physical examination using a variety of provocative maneuvers. PURPOSE/HYPOTHESIS: The purpose was to conduct a systematic review on the performance of physical examination maneuvers in diagnosing SLAP lesions and to perform a meta-analysis comparing the sensitivity and specificity of these examinations both individually and in combination. The null hypothesis stated that there would be no significant difference in the sensitivity or specificity of the included physical examination tests, neither individually nor in combination. STUDY DESIGN: Meta-analysis and systematic review; Level of evidence, 4. METHODS: A systematic review was performed with the inclusion criteria of studies that reported either the sensitivities and specificities or the number of true-positive, true-negative, false-positive, or false-negative results for at least 1 maneuver for identifying SLAP lesions. A meta-analysis was performed to determine the sensitivity and specificity of individual maneuvers. Additional analysis determined the performance of these maneuvers when combined in series and parallel. In series, all must be present to be considered positive. In parallel, any single positive test forces the overall combination to be considered positive. Only tests that were included in ≥3 studies were considered in the meta-analysis and those included in ≥4 studies were considered in the combination analysis. RESULTS: Overall, 862 studies were identified, 18 of which were included in the systematic review and meta-analysis. The physical examinations included were the O'Brien (n = 16), speed (n = 8), Yergason (n = 6), anterior slide (n = 8), crank (n = 7), Jobe (n = 5), dynamic labral shear (n = 3), Kim 2 (n = 3), and biceps groove tenderness tests (n = 3). All combinations of 2 to 5 maneuvers in both series and parallel were considered. The O'Brien and crank test combination was the most sensitive 2-test combination in both parallel and series. The Yergason and anterior slide test combination was the most specific 2-test combination in parallel and series. CONCLUSION: This systematic review and meta-analysis reports an updated meta-analysis considering the sensitivity and specificity of common physical examination maneuvers used in the diagnosis of SLAP lesions and considers these values for tests in both series and parallel combinations. The present analysis demonstrates improved specificities when tests are considered in series and improved sensitivities when considered in parallel combination.
Assuntos
Lesões do Ombro , Articulação do Ombro , Humanos , Sensibilidade e Especificidade , Exame Físico/métodos , Ombro , ArtroscopiaRESUMO
The purpose of this study was to evaluate the influence of anatomical factors degenerative superior labrum anterior to posterior lesion in rotator cuff tear. The study included 421 middle-aged patients treated using arthroscopic surgery for rotator cuff tears. Patients were divided into two groups based on the superior labrum anterior-to-posterior (SLAP). Glenoid inclination, glenoid length, humeral head diameter, acromio-humeral distance (AHD) head-glenoid difference (HGD), head glenoid angle (HGA), size and retraction of rotator cuff tears were evaluated in both groups. In conclusion, a HGD exceeding 10 mm could be anatomically predictive of degenerative SLAP. LEVEL OF EVIDENCE: Case series, Level IV.
RESUMO
Superior labrum anterior to posterior (SLAP) lesion is a tear of the superior labrum, which starts posteriorly and extends anteriorly to include the anchor of the biceps tendon to the superior labrum. Symptoms of SLAP tear may include pain or instability. Recently, with the development of arthroscopy, the diagnosis and treatment of SLAP lesion have been made a lot. However, the diagnosis of clinically relevant SLAP tears remains challenging because of the lack of specific examination findings and the frequency of concomitant shoulder lesion. And there is still controversy regarding the treatment. Accordingly, proper treatment is important through accurate evaluation of whether or not it is a clinically important SLAP lesion.
Assuntos
Artroscopia , Diagnóstico , Ombro , Lágrimas , TendõesRESUMO
Role of the superior labrum-biceps complex for the glenohumeral stability is still unclear. Nevertheless, isolated superior labrum anterior to posterior (SLAP) lesion can cause glenohumeral instability in young patient (especially in throwing athletes) and SLAP lesion are a well-known pathology entity in acute or chronic glenohumeral dislocation. Ten types of SLAP lesion have been classified by arthroscopic examination, among them type II and type IV through X SLAP can disturb glenohumeral stability by disrupting the anchoring of biceps. Arthroscopic repair of labrum is the most preferred method for SLAP lesion with glenohumeral instability in younger patient. Surgical treatment, if necessary, should address all aspects of the labral anatomy so that all the roles of the labrum in shoulder stability must be restored. In terms of restoration for glenohumeral instability, the good clinical results have been reported after arthroscopic repair of a SLAP with Bankart lesion. But, it is still a work in progress for long term clinical follow-up and understanding about relationship between SLAP lesion and glenohumeral instability.
