Regarding “diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions”

2012 ◽  
Vol 21 (12) ◽  
pp. e23-e24 ◽  
Author(s):  
Shawn W. O'Driscoll
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Tests ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Anterior Posterior

Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions

2012 ◽  
Vol 21 (1) ◽  
pp. 13-22 ◽  
Author(s):  
Chad Cook ◽  
Stacy Beaty ◽  
Michael J. Kissenberth ◽  
Paul Siffri ◽  
Stephan G. Pill ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Tests ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Anterior Posterior

scholarly journals Special Physical Examination Tests for Superior Labrum Anterior-Posterior Shoulder Tears: An Examination of Clinical Usefulness

2013 ◽  
Vol 48 (6) ◽  
pp. 856-858 ◽  
Author(s):  
Michelle A. Sandrey
Keyword(s):  
Systematic Review ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Confidence Intervals ◽  
Biceps Tendon ◽  
Tendon Injury ◽  
Slap Lesion ◽  
Superior Labrum ◽  
Posterior Shoulder ◽  
Anterior Posterior

Reference/Citation: Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior-posterior shoulder injuries are clinically limited and invalid: a diagnostic systematic review. J Clin Epidemiol. 2009;62(5):558–563. Clinical Question: The systematic review focused on diagnostic accuracy studies to determine if evidence was sufficient to support the use of superior labrum anterior-posterior (SLAP) physical examination tests as valid and reliable. The primary question was whether there was sufficient evidence in the published literature to support the use of SLAP physical examination tests as valid and reliable diagnostic test procedures. Data Sources: Studies published in English were identified through database searches on MEDLINE, EMBASE, and the Cochrane database (1970–2004) using the search term SLAP lesions. The medical subject headings of arthroscopy, shoulder joint, and athletic injuries were combined with test or testing, physical examination, and sensitivity and specificity to locate additional sources. Other sources were identified by rereviewing the reference lists of included studies and review articles. Study Selection: Studies were eligible based on the following criteria: (1) published in English, (2) focused on the physical examination of SLAP lesions, and (3) presented original data. A study was excluded if the article was limited to a clinical description of 1 or more special tests without any research focus to provide clinical accuracy data or if it did not focus on the topic. Data Extraction: The abstracts that were located through the search strategies were reviewed, and potentially relevant abstracts were selected. Strict epidemiologic methods were used to obtain and collate all relevant studies; the authors developed a study questionnaire to record study name, year of publication, study design, sample size, and statistics. Validity of the diagnostic test study was determined by applying the 5 criteria proposed by Calvert et al. If the study met the inclusion and validity criteria, 95% confidence intervals were calculated for each sensitivity, specificity, and positive and negative likelihood ratio reported. No specific information was provided about the procedure if the reviewers disagreed on how the evaluation criteria were applied. Main Results: The specific search criteria led to the identification of 29 full-text articles. The studies were reviewed, and inclusion and exclusion criteria were applied. This resulted in 14 excluded studies and 15 eligible studies for analysis. Of the 15 eligible studies, 1 evaluated only a single physical examination test for a SLAP lesion or biceps tendon injury, and 10 studies evaluated 2 to 6 physical examination tests for a SLAP lesion or biceps tendon injury. Nine studies reported sensitivities and specificities greater than 75%, 4 had sensitivities less than 75%, 3 had specificities less than 75%, 1 did not report sensitivity, and 2 did not report specificities. When validity was assessed for those 15 papers, only 1 study that evaluated the biceps tendon met the 5 critical appraisal criteria of Calvert et al and calculated 95% confidence intervals. When the Speed and Yergason tests were each compared with the gold standard (arthroscopy), the confidence intervals for the positive and negative likelihood ratios spanned 1. This indicated that the test result is unlikely to change the odds of having or not having the condition, respectively. Conclusions: The literature currently used as a reference for teaching in medical schools and continuing education lacks the necessary validity to help rule in or out a SLAP lesion or biceps tendon involvement. Based on the results from the systematic review conducted by Calvert et al, no tests clinically diagnose a SLAP lesion. This is a cause for concern as magnetic resonance imaging or magnetic resonance arthrography, which are frequently used to assess a possible SLAP lesion, may also have diagnostic flaws and may be cost prohibitive. Performing arthroscopy on every patient to rule the condition in or out is unethical, especially if a SLAP lesion is not present. More rigorous validity studies should be conducted for SLAP lesion physical examination tests using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool or Standards for Reporting Diagnostic Accuracy (STARD) criteria.

Arthroscopic Knot Removal for Failed Superior Labrum Anterior-Posterior Repair Secondary to Knot-Induced Pain

2017 ◽  
Vol 45 (11) ◽  
pp. 2563-2568 ◽  
Author(s):  
Jung Gwan Park ◽  
Nam Su Cho ◽  
Jung Youn Kim ◽  
Jong Hoon Song ◽  
Se Jung Hong ◽  
...  
Keyword(s):  
Pain Relief ◽  
Slap Lesions ◽  
Rotation Test ◽  
Sharp Pain ◽  
Superior Labrum ◽  
Slap Repair ◽  
Arthroscopic Knot ◽  
The Mean ◽  
Knot Removal ◽  
Anterior Posterior

Background: Studies on failed superior labrum anterior-posterior (SLAP) repair are increasing. However, the number of reports on treatment options for failed SLAP repair remains quite low, and the clinical results vary between different study groups. Purpose: To describe the clinical presentation of failed SLAP repair due to knot-induced pain and evaluate the efficacy of arthroscopic knot removal. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively reviewed records of 11 patients (mean age, 24.6 ± 8.6 years; range, 17-43 years) with stable, healed SLAP lesions with knot-induced pain after arthroscopic fixation of unstable type II SLAP lesions. All patients demonstrated a positive compression-rotation test before knot removal. The mean follow-up duration after knot removal was 48.0 ± 37.4 months (range, 24-156 months). The mean duration between primary fixation and knot removal was 21.2 ± 14.7 months (range, 8-56 months). Results: Sharp pain (100%) and clicking (64%) were the most common symptoms. The knot was positioned on the glenoid side in 5 patients and the labral side in 6 patients. The knots on the glenoid side had associated humeral head cartilage damage. The mean University of California at Los Angeles score significantly improved from 15.2 points to 31.7 points after knot removal ( P = .003) Additionally, the mean Constant score greatly improved from a mean of 56.5 points to 89.8 points ( P = .003). At a mean of 3 weeks after surgery, we observed dramatic pain relief. Six weeks after surgery, the compression-rotation test was negative in all patients. Conclusion: The most common symptom of knot-induced pain after SLAP repair was persistent sharp pain followed by clicking. The knot appears to be a cause of pain in failed SLAP repairs, and arthroscopic knot removal can provide dramatic pain relief and significant improvement of clinical outcomes.

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