Slap damage to the shoulder joint treatment. Injuries to the articular lip (including SLAP - damage)

most typical for those involved in throwing sports (most of the martial arts, for example, belong to them). Clinically characterized by tearing of the upper part of the articular lip shoulder joint - it is she who is associated with the tendon of the long head of the biceps.

SLAP Syndrome Symptoms

A reason to suspect that you have SLAP syndrome may be constant deep pain in the shoulder, wedging and discomfort in the shoulder joint, weakness of the muscles of the shoulder girdle. It should be remembered that SLAP-syndrome, as a rule, does not arise by itself, but as a result of an already suffered injury (most often - a dislocation), an unsuccessful fall on an unbent arm, or a direct strong blow to the shoulder. Chronic shoulder instability can also lead to it.

The main danger of SLAP is that the patient often does not remember the moment of the injury that led to the syndrome. It is common for professional athletes to ignore everyday microtraumas, which, by the way, can lead to such sad consequences as degenerative tearing of the upper part of the articular lip.

SLAP syndrome is diagnosed using computed or magnetic resonance imaging (MRI), as well as on the basis of a detailed history, which should indicate all the injuries and operations suffered.

An effective treatment for SLAP syndrome is

UDC 616.747.21-001

COLLISIONS IN SLAP DAMAGE CLASSIFICATION

V.G. Evseenko, I.M. Zazirny

Clinical hospital "Feofania", chief physician - I.P. Semeniv Kiev, Ukraine

There is no agreement among specialists regarding the classification of injuries to the tendon of the long head of the biceps brachii in the area of \u200b\u200battachment to the scapula. Some authors, describing this damage, take as a basis the classification of S.J. Snyder, others describe it as a separate injury. A review of the existing classifications of damage to the upper part of the articular lip of the scapula (the so-called SLAP damage) and damage to the tendon of the long head of the biceps brachii is presented.

Key words: shoulder joint, biceps tendon, SLAP damage, classification.

COLLISIONS IN THE CLASSIFICATION OF SLAP LESIONS

V.G. Yevsyeyenko, I.M. Zazirniy

Clinical hospital "Feofania"

There is no agreement among experts on the classification of injury of o the long head tendon of biceps brachii in the area of \u200b\u200bits attachment to the shoulder blade. Some authors take the Snyder's classification as basis; others describe it as a separate injury. The authors presented the review of existing classifications of the labrum shoulder injury (so-called SLAP lesions) and traumas of the tendon of the long head biceps.

Key words: shoulder joint, biceps tendon, SLAP injury classification.

Injuries to the tendon of the long head of the biceps brachii in the area of \u200b\u200battachment to the scapula, as well as injuries to the upper part of the articular lip of the scapula, are closely related and at the same time varied in morphological features, which can be difficult to diagnose. Analyzing the literature data, we encountered a lack of general agreement regarding the classification of injuries to the tendon of the long head of the biceps brachii (BCD) in the area of \u200b\u200battachment to the scapula. Some authors take S.J. Snyder, others see it as a separate injury.

It is necessary to remember about the different options for fixing the tendon of the DG DMP. According to G.D. Giacomo, the DG tendon DMP can be attached directly to the supra glenoid tubercle in 30% of cases, to the lip and tubercle simultaneously in 25% of cases, and in 45% of cases directly to the upper part of the articular lip (ICH) of the shoulder blades.

Type 1 - tendon DG DMP is woven completely into the back of the lip;

Type 2 - tendon DG DMP is woven mainly into the back of the lip, giving a small portion of the fibers to the front;

Type 3 - the number of fibers with which the DG DMP tendon is woven into the anterior and posterior parts of the lip is the same;

Type 4 - the tendon DG DMP is woven mainly into the anterior part of the lip, giving a small portion of fibers to the posterior part

In 1979, P. Slatis and K. Aalto divided the damage to the tendon of the DG DMP into three types: impingement, instability and intra-articular tendinitis.

For the first time, P. Habermeyer and G. Walch published the classification of instability of the tendon DG DMP. They defined subluxation of the tendon DG DMP as a partial or complete short-term loss of contact between the tendon and its bony groove. In 1996

three different types of subluxation of the tendon DG DMP have been described:

Upper subluxation (Walch I): an injury between the upper humeral-scapular ligament and the coracohumeral ligament (the so-called interrotator interval) leads to a loss of stability of the tendon of the DG of the DMP above the entrance to the intertubercular zone; the subscapularis tendon remains intact, preventing complete dislocation of the DG DMP tendon;

Subluxation in the intertubular groove (Walch II): the injury is located below the entrance to the bone groove; in this type of lesion, the tendon of the DG DMP slides over the medial edge of the bone groove towards the lesser tuberosity humerus... The cause of the disease is damage to the outer fibers of the subscapularis tendon;

Incorrect tissue fusion after injury to the lesser tuberosity of the humerus (Walch III): a fracture in the lesser tuberosity of the humerus can lead to improper tissue fusion after injury, which creates conditions for subluxation of the tendon of the DG UD.

At the same time, two types of tendon dislocation of the DG DMP were described, which were based on pathomorphological features:

Type I: extra-articular dislocation with partial damage to the subscapularis tendon. With this type of damage, the outer fibers of the tendon of the subscapularis muscle are completely torn (with the condition of maintaining deep fibers), and partial damage to the rotator cuff is often determined; the tendon DG DMP emerges from the intertubercular sulcus medially and is located between the tendon of the subscapularis muscle and the clavicular-thoracic fascia.

Type II: intra-articular dislocation with complete damage to the subscapularis tendon. In this type of injury, the tendon of the DG DMP is flattened and expanded; As a result of full-thickness damage to the tendon of the subscapularis muscle, the tendon of the DG DMP is displaced into the shoulder joint downward and medially, the damage is often combined with massive injuries of the rotator cuff of the shoulder.

In 1999, K. Yamaguchi and R. Bindra categorized damage to the tendon of the long head of the biceps brachii as inflammatory, unstable, or traumatic. The principle of the damaging factor was taken as a basis (Fig. 1, Table 1).

Normal tendon;

Chronic inflammation

Fibrosis of the tendon;

Mucous degeneration;

Vascular disorders;

Dystrophic calcification;

Acute inflammation.

Fig. 1. MRI, axial projection: dislocation of the tendon of the DG DMP

In the domestic literature, we found a modification of the Snyder classification, which combines injuries of the upper part of the articular lip of the scapula and the tendon of the long head of the biceps brachii:

Types I-IV correspond to the S.J. Snyder;

Type V: against the background of pronounced degenerative changes in the upper part of the glenoid lip of the scapula with the spreading of its free edge, there is a complete separation of the tendon of the long head of the biceps brachii from the attachment site (Fig. 2).

Figure: 2. Type V by

modified Snyder classification

Table 1

Tendon injury D

D DMP K. Yamaguchi and R. Bindra

Description

Inflammatory

changes

DG DMP tendon instability

Traumatic

A - subluxation

A - traumatic ruptures

B - damage to the area of \u200b\u200battachment to the blade

dG tendonitis DMP DMP along with rotator cuff disease isolated DG tendon tendonitis DMP

superior subluxation

subluxation in the proximal part of the intertubercular sulcus subluxation as a result of inadequate restoration of the lesser tuberosity of the humerus after injury

extra-articular, associated with partial injury of the subscapularis tendon

intra-articular, connected with complete damage to the tendon of the subscapularis soft muscle

partial

types I-IV corresponding to Snyder types I-IV SLAP

table 2

Topographic classification of damage to the tendon DG DMP A. Hedtmann

Damage Zone Description

Damage to the attachment point of the DG tendon DMP I I-IV types according to Snyder Injuries described by Andrews

Injury of the DG tendon DMP over the tubercles of the humerus II Isolated tendonitis / tendinosis Partial injury Partial injury with damage to the rotator cuff Supra-humeral instability (Walch I)

Injuries in the intertubercular groove III Subluxation or dislocation of the DG tendon DMP (Walch II) without damage to the rotator cuff, often accompanied by damage to the subscapularis tendon

Damage below the groove of the DG tendon DMP IV Peripheral damage to the DG tendon DMP (including in the soft muscle-tendon part)

Table 3

Tendon injury classification

DG DMP by L. Lafosse

Degree of damage Description of damage

0 Normal tendon

1 Minor injury (localized partial injury, less than 50% of tendon thickness)

2 Extensive injury (significant damage to the tendon, more than 50% of the tendon thickness)

Damage to the lip of the scapula was almost unknown before the advent of the arthroscope, but damage to this lip area is important because it is the main site of attachment of the DG BPD tendon.

In the English-language literature, the abbreviation "SLAP" is common: damage to the upper part of the articular lip of the scapula. For the first time, injuries to the upper part of the articular lip of the scapula were described by J.R. Andrews et al in 1985. The authors did not separate and did not systematize the diseases, describing the damage to the upper part of the articular lip (ICHS) of the scapula together with damage to the tendon of the long head of the biceps brachii (DG DMP), while pointing to the tendon DG DMP as the cause of the damage to the HCH.

In 1990 S. Snyder et al. Published an article in which the authors defined the term SLAP: “One such injury pattern involves the superior aspect of the glenoid labrum, in which the injury begins posteriorly and extends anteriorly, stopping at or above the mid-glenoid notch. For simplicity, we call this injury pattern a "SLAP"

lesion (Superior Labrum Anterior and Posterior) "(One of these types of injury involves damage to the upper lip of the scapula that starts posteriorly and extends forward, ending at or above the midpoint of the articular notch. For simplicity, we call this type of injury SLAP injury ). In 2010 S.J. Snyder et al confirmed the definition of SLAP as damage to the upper lip of the scapula.

In 1990 S.J. Snyder was the first to systematize CSV damage by describing four types of lip injury.

SLAP: type I - degenerative changes in the upper part of the glenoid lip of the scapula with expansion of its edge, the edge of the lip is firmly attached to the bone, the damage does not extend to the tendon DG DMP (Fig. 3).

SLAP: type II - VCGS is completely detached from the site of attachment to the scapula. When the tendon of the DG DMP is stretched, there is a rise in the scapula ICSV with exposure of the bone (Fig. 4).

SLAP: Type III - longitudinal tear of the ICHS, which resembles a "watering can handle" meniscus tear. The place of attachment of the tendon of the DG DMP remains intact (Fig. 5).

SLAP: type IV - longitudinal rupture of the scapula ICSG resembles a meniscus rupture of the "watering can handle. This rupture extends to the tendon of the DG DMP, delaminating it longitudinally (Fig. 6)

SLAP types I-IV correspond to S.J. Snyder. The author identified additional injuries that occurred in 38% of patients:

SLAP: type V - Bankart injury with continuation of the scapula to the ICHS (Fig. 7);

SLAP: type VI - lesions in the form of an anterior or posterior flap of the CSF with a branch of the tendon of the DG DMP from above (Fig. 8).

Figure: 3. SLAP: type I: a - sagittal view; b - frontal cut; c - MRI, coronary projection

SLAP type VII - lesions in the form of a branch of the CSF together with the tendon of the DH of the DMP, which spreads along the middle shoulder-scapular connection (Fig. 9).

SLAP type IIA - anterosuperior damage to the articular lip;

SLA P type II B - posterosuperior damage to the articular lip;

SLAP type II C - combined anteroposterior injury (Fig. 10).

During 1997-2000. three more types of scapula ICHS injuries were proposed, which were presented at conferences and proposed as a possible extension of the existing classification:

SLAP VIII - lesion of the SLAP IIB type, but with a large extension to the posterior part of the lip (Resnick D.) (Fig. 11);

SLAP IX - complete or almost complete damage to the articular lip of the scapula (Fig. 12);

SLAP X - damage to the CSHG with an extension of the interrotator interval (Beltran J.) (Fig. 13).

Figure: 7. SLAP type V: a - sagittal view; b - MPT, coronary projection; c - MPT,

axial projection

Figure: S. SLAP type VI: a - sagittal view; b - MPT, coronary projection; c - MPT, axial projection

Figure: 9. SLAP: type VII: a - sagittal view; b - MRI, axial projection; c - MRI, scythe sagittal projection

Figure: 10. SLAP-II: a - type II A; b - type II B; c - type II C

Figure: 11. SLAP VIII: a - damage scheme, sagittal view; b - MPT coronary projection; c - MPT, axial projection

Discussion

Back in 1949, A.E BePalasha and co-authors described anatomical variants of the normal development of the articular lip of the scapula, including pockets or grooves of the lip, openings between the lip and the adjacent cartilage of the scapula, which can create a false appearance of damage when performing magnetic resonance imaging or ultrasound examination [cit. by 17]. B.Zh.Byler reported the prevalence of this phenomenon in 11% of patients, M.M. ^ Inamis with co-authors - in 12%, and E11man and Oalishan [cit. by 5] - in 15% of patients. Standard MRI may not always detect and distinguish lesions. In this case, an MRI scan with special provocative shoulder pads (ABSH, ABEI, AVEI) could help to identify such injuries (Fig. 14).

At the same time, it is necessary to remember about the anatomical variants of the normal structure and location of the ICSG - two types of attachment to the scapula periosteum (solidarity and meniscal), various types of attachment of the tendon -

liya DG DMP. Also, one should not forget about the opportunity to come into contact with such a rare variant of the normal structure of the articular lip of the scapula, such as Buford-complex, which can occur in 1.5% of patients.

Currently, there are opinions in the literature that it is impossible to accurately differentiate all ten types of SLAP lesions during MRI. In addition, no agreement was reached on the formal introduction of VIII-X types of SLAP damage.

It should be emphasized that the difference in the distribution of damage to the tendon of the DG DMP according to the damaging factor is not always clearly tracked: degenerative or inflammatory changes in the tendon can more likely lead to injury and, conversely, repeated injury can lead to changes in the tendon, which will not differ from inflammation. However, this classification can help with the distribution of these disorders by pathogenesis, as well as in the development of protocols to ensure optimal treatment.

There is an opinion about the need to isolate the damage to the scapula VCHS in a separate

Figure: 12. SLAP IX: a - lesion diagram, sagittal view; b - MPT, coronary projection; c - MPT, axial projection

Figure: 13. SLAP X: a - damage scheme, sagittal view; b - MPT, coronary projection; c - MPT, axial projection

Figure: 14. Performing MRI of the shoulder joint in a special packing AOSH (Adduction internal rotation)

disease, since SLAP is very often the only pathology of the tendon of DG DMP, especially in young athletes.

In the literature, the classification of injuries to the upper part of the articular lip of the scapula S.J. Snyder. Expanding the existing classification is an attempt to highlight related anomalies and amounts to

a promising direction in the diagnosis of this damage, since it allows to comprehensively consider the problem of damage to the scapula HCHS and select the optimal treatment.

At the same time, the definition of damage to the tendon of the long head of the biceps brachii muscle as a driving force in damage to the proper articular lip of the scapula, in our opinion, will make it possible to clearly distinguish and classify these two pathologies.

Literature

1. Strafun S.S., Sergienko R.A., Strafun A.S. Surgical treatment of injuries of the attachment site of the tendon of the long head of the biceps brachii. Vestn. orthopedics, traumatology and prosthetics. 2011; (3): 5-10.

2. Andrews J.R., Carson W.G. Jr., McLeod W.D. Glenoid labrum tears related to the long head of the biceps. Am. J. Sports Med. 1985; 13 (5): 337-341.

3. Chhadia A.M., Goldberg B.A., Hutchinson M.R. Abnormal translation in SLAP lesions on magnetic resonance imaging abducted externally rotated view. Arthroscopy. 2010; 26 (1): 19-25.

4. Elser F., Braun S., Dewing C.B., Giphart J.E., Millett P.J. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011 Apr; 27 (4): 581-592.

5. Giacomo G.D., Pouliart N., Costantini A. Vita A. Atlas of functional shoulder anatomy. Milan; New York: Springer-Verlag; 2008.231 p.

6. Habermeyer, P., Walch G. The biceps tendon and rotator cuff disease. In: Rotator cuff disorders. Baltimore etc: Williams and Wilkins, 1996. pp. 142-159.

7. Habermeyer P., Magosch P., Pritsch M., Scheibel M.T., Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J. Shoulder Elbow Surg. 2004; 13 (1): 5-12.

8. Hedtmann A., Fett H., Heers G., Lasionenim Bereich des Rotatorenintervalls und der langen Bizepssehne. In: Schulter: das Standardwerk fur Klinik und Praxis. Stuttgart: Georg Thieme Verlag; 2002. p. 310-316.

9. Higgins L.D., Warner J.J. Superior labral lesions: anatomy, pathology, and treatment. Clin. Orthop. 2001; (390): 73-82.

10. Lafosse L., Reiland Y., Baier G.P., Toussaint B., Jost B. Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy. 2007; 23 (1): 73-80.

11. Lichtenberg S., Magosch P., Habermeyer P. Superior labrum-biceps anchor complex. Orthopade. 2003; 32 (7): 616-626.

12. Maffet M. W., Gartsman G. M., Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am. J. Sports Med. 1995; 23 (1): 93-98.

13. Mohana-Borges A.V., Chung C.B., Resnick D. Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. AJR Am. J. Roentgenol. 2003; 181 (6): 1449-1462.

14. Morgan C.D., Burkhart S.S., Palmeri M., Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998; 14 (6): 553-565.

15. Murthi A. M., Vosburgh C. L., Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J. Shoulder Elbow Surg. 2000; 9 (5): 382-385.

16. Slatis P, Aalto K. Medial dislocation of the tendon of the long head of the biceps brachii. Acta Orthop. Scand. 1979; 50 (1): 73-77.

17. Smith D.K., Chopp T.M., Aufdemorte T.B., Witkowski E.G., Jones R.C. Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination. Radiology. 1996; 201 (1): 251-256.

18. Snyder S.J., Karzel R.P., Pizzo W.D., Ferkel R.D., Friedman M.J. Arthroscopy classics. SLAP lesions of the shoulder. Arthroscopy. 2010; 26 (8): 1117.

19. Snyder S.J., Karzel R.P., Del Pizzo W., Ferkel R.D., Friedman M.J. SLAP lesions of the shoulder. Arthroscopy. 1990; 6 (4): 274-279.

20. Stoller D.W. MR arthrography of the glenohumeral joint. Radiol. Clin. North Am. 1997; 35 (1): 97-116.

21. Tuite M.J., Blankenbaker D.G., Seifert M., Ziegert A.J., Orwin J.F. Sublabral foramen and buford complex: inferior extent of the unattached or absent labrum in 50 patients. Radiology. 2002; 223 (1): 137-142.

22. Vangsness C.T. Jr., Jorgenson S.S., Watson T., Johnson D.L. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J. Bone Joint Surg. Br. 1994; 76 (6): 951-954.

23. Vanhoenacker F.M., Maas M., Gielen J.L. Imaging of orthopedic sports injuries. Heidelberg, Berlin: Springer-Verlag; 2007.535 p.

24. Williams M.M., Snyder S.J., Buford D. Jr. The Buford complex - the "cord-like" middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy. 1994; 10 (3): 241-247.

25. Yamaguchi K., R. Bindra Disorders of the biceps tendon. In: Disorders of the shoulder: diagnosis and management. Philadelphia: Lippincott Williams 1999.

Evseenko Vyacheslav Grigorievich - Ph.D. traumatologist-orthopedist of the Center for Orthopedics, Traumatology and sports medicine

e-mail: [email protected];

Zazirny Igor Mikhailovich - Doctor of Medical Sciences Head of the Center for Orthopedics, Traumatology and Sports Medicine e-mail: [email protected]

Specialized clinics in Germany are very popular in the treatment of pathological processes in the shoulder joint. Clinic "Sankt Augustinus Krankenhaus Düren" also specializes in the treatment of various pathologies of an orthopedic orientation. Including - SLAP (SLEP) lesions of the shoulder joint. On the recommendation of the doctors of the clinic "Sankt Augustinus Krankenhaus Düren", it may be recommended to undergo an examination whether the patient has any.

Damage to the shoulder joint

Of all human joints, the shoulder is the most mobile. It takes on a huge load, even with the most common movements. Any, even the most insignificant injuries or minor dislocations, can be accompanied by SLEP syndrome - caused by pathology in the area of \u200b\u200battachment of the biceps and the upper cartilaginous ridge (lip). The glenoid cavity of the shoulder is small in relation to the head of the key bone, and to prevent its dislocation from its bed, the edges of the glenoid cavity are, as it were, augmented with a cartilaginous roller (glenoid lip) to enlarge the glenoid cavity. The biceps muscle of the shoulder is attached to the upper part of the cartilage ridge. The lesions in this area of \u200b\u200bthe shoulder joint are called SLAP syndrome

Shoulder SLAP syndrome. Pathological mechanism

The pathological mechanism of damage is due to several factors:

Compression factor - damage to the shoulder, as a result of the impact of an outstretched arm at the time of the fall.
Tension factor - a consequence of water skiing.
Layering factor - the manifestation of the syndrome is associated with a sharp movement of the hands raised to the level of the head - this may be associated with a throwing sport.

Signs of the disease

Signs of SLAP lesions are manifested by the following characteristic symptoms:

a pronounced feeling of pre-dislocation;
the manifestation of pain in the anterior articular part of the shoulder at the time of stress;
pain does not disappear, even with intra-articular administration of corticosteroid drugs;
in the process of external rotation, there are radiating, laterally shifting pains, at rest and sleep;
pain sensations are manifested on palpation of the upper antero-outer part of the shoulder, with a ten-degree displacement (internal rotation).

Classification of the disease

The pathological processes associated with shoulder SLAP syndrome are classified by type, depending on the degenerative changes in the shoulder complex.

First type - characterized by changes in the upper part of the cartilage ridge and splitting of the fibers of the long biceps tendon, without signs of detachment.
Second type, caused by the breakage of the upper part of the cartilaginous ridge together with the biceps muscle from the upper, narrow part of the articular notch (cavity).
Third type degenerative changes are characterized by horizontal splitting of the upper part of the cartilaginous ridge ("damage - watering can handle").
Fourth type changes are expressed by longitudinal delamination of the biceps muscle and displacement of the complex - articular lip + biceps into the articular cavity.

DoctorsClinics "SanktAugustinusKrankenhausDüren »Dr. Hillekamp, \u200b\u200bDr. Krupa and dr. Diensknecht, have extensive experience in treatment pathological changes shoulder girdle. With the assistance of the "Russian-German Medical Center", which is the official representative of this Clinic, anyone can go through complex treatment in fact high level... To do this, you need to make a request for treatment on our website.

Pathology treatment

In Germany, a separate approach (differentiated) is used, depending on the type of degenerative changes.

To restore the integrity of the tendons, a primary or secondary tendon suture is applied, and arthroscopic refixation is performed.

In the course of operations caused by SLAP syndrome of the shoulder joint, the shoulder complex is attached to the edge of the glenoid cavity or the tendon is fixed to the original bed using suture anchoring.

SLAP syndrome

Damage to the upper lip is often caused by direct trauma, such as falling onto an outstretched arm. Often, with prolonged engagement in throwing sports or weightlifting, gradual damage to the articular lip may occur. In some cases, SLAP damage can result from a dislocated shoulder.

Symptoms

The main symptoms of SLAP injury are pain in the front of the shoulder, clicks and crackling when moving in the shoulder joint. Against the background of pain, a decrease in the volume of active movements, especially above the head, progresses, and later stiffness in the joint develops. If the lip is damaged, some patients may feel instability in the shoulder joint, with some movement.

Diagnosis

A physician may suspect an injury to the labrum based on the history and clinical examination. During a clinical examination, the doctor conducts special stress tests, identifying symptoms characteristic of the disease. MRI and X-ray of the shoulder joint are not very sensitive to damage to the articular lip.

In this connection, the diagnosis of damage to the articular lip is significantly difficult. Arthroscopy can be used to confirm the diagnosis. An arthroscope is a small optical device connected to a video camera and a monitor, which is inserted into the joint cavity through a skin puncture.

During the operation, you can examine the joint cavity, diagnose damage to the articular lip, and perform reconstruction.

Treatment

Treatment usually begins with conservative measures. The main goal is to reduce pain and inflammation in the joint. Therapy is also a priority, mainly physiotherapy exercises aimed at preventing joint stiffness. Your doctor may prescribe cortisone injections into the joint. Cortisone is a very powerful anti-inflammatory drug that, when injected into a joint, significantly reduces pain. However, it is worth noting that the relief from pain is only temporary. If within 3-4 months conservative treatment not effective, the pain syndrome does not stop, and the range of motion in the joint decreases progressively, the question of surgery can be considered.

For surgical treatment arthroscopic injuries, including SLAP damage, are currently used. If the area of \u200b\u200bthe damaged lip is small and does not affect its entire thickness, the lip is not pinched between the head and the glenoid during movements, it is possible to restrict itself to debridement. Debridement is performed with special arthroscopic mechanical instruments or with cold plasma (cold plasma ablation). As a result of debridement, irregularities are smoothed out, as well as areas of fibration of the articular lip. During debridement, it is possible to resect the marginal and partially torn fragments of the articular lip and the biceps tendon, which, when moving in the shoulder joint, "wear out" the articular cartilage and contribute to chronic inflammation.

If the rupture of the articular lip is significant, and instability is determined in the shoulder joint, its refixation, rather than simple removal, may be required.

During arthroscopy, the site of injury is visualized, canals are drilled in the bone in the projection of separation, and special anchor fixators (anchors) are inserted into them, to which the articular lip is fixed with heavy-duty threads. The operation may require multiple anchors.

Anchor clamps (anchors) can be made of metal or special absorbable material. After some time, the articular lip grows to the bone. The anchor clips do not need to be removed in the future.

In some cases, with significant damage to the tendon of the biceps muscle, its tenodesis is performed.

Tenodesis is an operation to cut the biceps tendon from the scapula and fix it to a new place in the proximal humerus.

With tenodesis, the relief of the shoulder muscles does not suffer. The operation leads to a sharp decrease pain syndrome in the area of \u200b\u200bthe shoulder joint.

There are many methods for arthroscopic tenodesis of the biceps tendon.

Anchor clamps (anchors) or special screws can be used to fix the tendon to the bone.

The advantage of arthroscopic tenodesis is the reduction in the degree of damage to the unaltered tissues surrounding the joint, which leads to faster healing and recovery.

Rehabilitation

After tenodesis and joint lip re-fixation, a special orthosis bandage is prescribed, most often passive movements in the elbow and shoulder joints are allowed immediately after the operation.

However, active movements of the operated arm are limited to a month and a half after the operation. More aggressive rehabilitation can lead to the tearing of the biceps tendon and articular lip from the reflex site to the bone. You can usually return to sports 4-6 months after surgery. The debridement operation involves more active rehabilitation, which begins immediately after the operation. Sutures from the skin after arthroscopic shoulder surgery are usually removed on the 10th day.

SLAP - syndrome (Superior Labrum Anterior to Posterior) - damage to the upper part of the articular lip associated with the long head of the biceps brachii. It is most typical for athletes involved in throwing sports (baseball, rugby) and martial arts (wrestling, judo, sambo), as well as for people whose job is to lift heavy objects.

Main feature of this damage is that the patient usually does not remember the moment when he was injured, especially when it comes to a professional athlete: everyday micro-injuries are most often left without proper attention, thereby provoking degenerative changes in the complex of the upper lip and the tendon of the long head of the biceps.

SLAP syndrome, as a rule, does not occur on its own, but is most often a consequence of an already suffered injury (in most cases it is a dislocation). The reason may be a fall on an outstretched or abducted arm, excessive load when lifting weights, as well as a direct blow to the shoulder.

Classification of SLAP lesions:

Type I: degenerative changes in the upper lip and biceps attachment without detachment, but with splitting into fibers.
Type II: breakage of the upper lip and biceps tendon complex from the upper glenoid cavity.
Type III: damage to the "watering can handle" of the upper articular lip.
Type IV: longitudinal dissection of the long biceps tendon with dislocation of the upper lobe of the lip-biceps down into the joint cavity.

At the heart of the mechanism of injury lies the effect of force on the tense tendon of the biceps brachii, which cannot withstand and is damaged along with the articular lip. The main types of injury mechanisms:

squeezing (falling onto the abducted hand);
tension (for example, muscle tension in the shoulder while water skiing);
stratification (for example, throwing shells and other types of physical activity associated with moving the arms over the head).

Symptoms

The patient complains of pain in the anterior region of the shoulder joint during sports exertion, periodic sensation of "pre-dislocation", pain at rest and during sleep radiating laterally during external rotation, pain on palpation of the intertubercular sulcus at 10 degrees of internal rotation, periodic wedging in the shoulder area, weakness of the muscles of the shoulder girdle and, in general, general discomfort in the disturbing joint. To determine the most painful movements, special tests are usually used: