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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Shoulder problems are common in overhead sports like baseball, basketball and volleyball. Although gymnastics also includes overhead activities, there are few reports about shoulder problems in this sports activity. During the time period 1992-1995 we treated five young competitive gymnasts for shoulder pain. Arthroscopy revealed that they were all suffering from SLAP lesions or other labral pathology, although they had never dislocated their shoulders. These injuries have not been described earlier in connection with gymnastics. In a survey of 13 gymnasts in an elite club, we found that six (46%) complained about shoulder pain. Since four of these athletes explained that their shoulder pain started acutely during ring exercises in suspension while one suffered a slower onset with pain also during parallel bar exercises, we undertook an electromyographic study of the shoulder musculature of three normal elite gymnasts during exercises on the parallel bars and rings. We found that during the ring exercises in suspension there was a "critical phase" during which the muscle activity around the shoulder was very low, leading to great articular stresses. This might explain the occurrence of labral lesions like the SLAP lesions in this type of athlete. If shoulder pain in elite gymnasts does not respond to rest and physical therapy over 2-3 months, a shoulder arthroscopy should be considered.
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PMID:An arthroscopic and electromyographic study of painful shoulders in elite gymnasts. 881 62

Glenoid labral cysts are commonly associated with labral tears, which can cause pain or instability. We present the case of a patient, referred for neurological complaints, who was actually suffering from supraspinatus nerve entrapment syndrome. Electroneurogram studies showed an isolated lesion of the branch to the infraspinatus muscle. Magnetic resonance imaging confirmed a glenoid labral cyst extending from the cranial glenoid to the scapular notch. After arthroscopic debridement of an extended SLAP-lesion that had caused joint fluid extrusion, the dissolution of the cyst was associated with complete neurological recovery. The patient is pain free and range of motion is normal. An attempt at an arthroscopic procedure seems warranted in cases like this, since cysts that accompany labral tears can dissolve after rigorous debridement of the torn labrum, much like meniscal cysts. Extended and hazardous open excisions can thus be avoided.
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PMID:Glenoid-labral cyst entrapping the suprascapular nerve: dissolution after arthroscopic debridement of an extended SLAP lesion. 944 31

The following statements summarize this article: Three distinct categories of Type 2 SLAP lesions exist: (1) anterior, (2) posterior, and (3) combined anteroposterior. Posterior Type 2 SLAP lesions have distinct clinical and anatomic features that distinguish them from anterior Type 2 SLAP lesions. Posterior and combined Type 2 SLAP lesions can be disabling to overhead-throwing athletes because of posterosuperior instability and anteroinferior pseudolaxity. The Jobe relocation test is positive with posterosuperior pain in patients with posterior or combined anterior-posterior Type 2 SLAP lesions and is negative in patients with anterior Type 2 SLAP lesions. Rotator cuff tears are frequently associated with posterior or combined anterior-posterior SLAP lesions, are lesion-location specific, and typically begin from inside the joint as undersurface tears. Repair of posterior SLAP lesions can return overhead-throwing athletes to full overhead athletic functioning. The peel-back mechanism is a likely cause of posterior Type 2 SLAP lesions. To securely repair the posterosuperior labrum to resist torsional peel-back, sulure anchors must be placed posterior to the biceps at the corner of the glenoid. The repair must be protected against external rotation past 0 degree for 3 weeks to avoid undue premature torsional stresses on the repair from the peel-back mechanism. A tight posteroinferior capsule predisposes to Type 2 SLAP lesions in overhead athletes. Shoulders at risk for the dead arm syndrome have a marked loss of internal rotation caused by contracture of the posteroinferior capsule such that less than a 180 degrees arc of rotation is achieved with the arm abducted 90 degrees (the 180 degrees rule). Type 2 SLAP lesions that cause the dead arm syndrome in overhead-throwing athletes are most likely acceleration injuries that occur in late cocking rather than deceleration injuries in follow-through. Rehabilitation of athletes with the dead arm syndrome must include the entire kinetic chain. The root cause of the dead arm syndrome is the Type 2 SLAP lesion.
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PMID:Shoulder injuries in overhead athletes. The "dead arm" revisited. 1065 69

Thirteen overhand-throwing athletes who failed at least 3 months of physical therapy while restricted from throwing and who demonstrated a positive modified relocation test at 90 degrees, 110 degrees, and/or 120 degrees were clinically and arthroscopically examined. On arthroscopic examination, all patients demonstrated articular surface pathology. Eleven patients had fraying of the undersurface of the rotator cuff, and 10 patients had fraying of the posterosuperior labrum. With 90 degrees shoulder abduction, 8 patients had rotator cuff contact with the posterosuperior labrum. When the shoulder was abducted to 110 degrees, all patients demonstrated such contact. At 120 degrees of abduction, 12 patients revealed contact. The presence or absence of pain during the modified relocation test correlated with the presence or absence of cuff contact with the posterosuperior labrum 79% of the time. Six patients had a positive modified relocation test at all levels of abduction. These patients included 2 with SLAP lesions, 1 with a Bankart lesion, and 1 with a complete tear of the rotator cuff.
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PMID:A modification of the relocation test: arthroscopic findings associated with a positive test. 1164 12

Since their first description several years ago, superior||| glenoid labral lesions have increasingly been blamed for shoulder problems||| associated with sports. Originally merely describing arthroscopically visible||| upper labral/biceps abnormalities, the current understanding is that often||| clinical problems such as impingement pain or even rotator cuff disease can be||| secondary to these lesions, especially in overhead athletes. Impingement in||| these cases is caused by superior shoulder instability originating from an||| unstable biceps insertion that is present for example in SLAP (superior labrum||| from anterior to posterior) lesions. Additional problems such as internal or||| posterosuperior impingement that are often found simultaneously in these||| patients are pathomorphologically located in the same anatomical region and||| therefore make exact diagnosis and thus treatment more complex. Magnetic||| resonance imaging with intra-articular contrast enhancement and particularly||| arthroscopy are the primary tools for exact diagnosis and classification of||| superior labral/biceps pathology. Therapeutically, lesions with unstable biceps||| origin (SLAP types 2 and 4) require operative refixation, as we have seen in||| our 50 cases in the last 4 years, in order to reestablish the stabilising||| effect of the biceps tendon for the shoulder joint. The arthroscopic technique||| for repair of these lesions using different devices of implantable suture||| anchors is presented. Long-term pain-free shoulder function in competitive||| athletes, throwers in particular, thus requires anatomical reconstruction of||| the originally unstable biceps, which is the causal therapy for these||| lesions.
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PMID:[In Process Citation] 1111 42

Since their first description several years ago, superior glenoid labral lesions have increasingly been blamed for shoulder problems associated with sports. Originally merely describing arthroscopically visible upper labral/biceps abnormalities, the current understanding is that often clinical problems such as impingement pain or even rotator cuff disease can be secondary to these lesions, especially in overhead athletes. Impingement in these cases is caused by superior shoulder instability originating from an unstable biceps insertion that is present for example in SLAP (superior labrum from anterior to posterior) lesions. Additional problems such as internal or posterosuperior impingement that are often found simultaneously in these patients are pathomorphologically located in the same anatomical region and therefore make exact diagnosis and thus treatment more complex. Magnetic resonance imaging with intra-articular contrast enhancement and particularly arthroscopy are the primary tools for exact diagnosis and classification of superior labral/biceps pathology. Therapeutically, lesions with unstable biceps origin (SLAP types 2 and 4) require operative refixation, as we have seen in our 50 cases in the last 4 years, in order to reestablish the stabilising effect of the biceps tendon for the shoulder joint. The arthroscopic technique for repair of these lesions using different devices of implantable suture anchors is presented. Long-term pain-free shoulder function in competitive athletes, throwers in particular, thus requires anatomical reconstruction of the originally unstable biceps, which is the causal therapy for these lesions.
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PMID:[Superior labrum pathology in the athlete]. 1114 11

Most instabilities or pain syndromes are associated with injuries or morphologic changes in the glenoid labrum complex or long head of the biceps tendon origin. The first anatomic descriptions go back to Fick in 1910 and since then many authors have described the anatomy of these structures. It was Snyder who introduced the term SLAP lesions, classifying superior, anterior, posterior labrum changes into four grades. It is still unclear whether all of the described and arthroscopically observed changes are due to a post-traumatic, acquired lesion or whether anatomic variations can be present as well. In order to elucidate this problem, 36 cadaver shoulder joints were inspected macroscopically and sectioned for microscopic evaluation. Here the glenoid could be divided into an superior and an anterior- superior area demonstrating a wide variety of morphologic labral glenoid changes, while the dorsal and inferior sectors of the glenoid showed a relatively uniform anatomy of a firm labrum-glenoid bond. Four types of biceps tendon attachments could be identified similar to the description given by Vangsness. In addition, a variety of anterior-superior changes could be found. The sublabral hole as described by Esch in the clinical setting was found to be a physiologic variant. Precise knowledge of the anatomic morphology of the normal glenoid in its variations seems to be necessary to understand variants and allow for distinguishing between physiologic anatomic variants and pathoanatomic changes in imaging and the clinical setting.
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PMID:[Anatomy of the glenoid labrum]. 1288 56

SLAP lesions disrupt the perilabral architecture, but so far there have been no reports about posterior instability due to SLAP lesions. In a prospective study of 30 patients with recurrent posterior instability, we found SLAP lesions as a reason for instability in three cases. The purpose of this study is to point out that SLAP lesions can be a cause of posterior instability. Thirty patients with clinical posterior shoulder instability underwent diagnostic arthroscopy before operative stabilization procedures, three of whom (three males, aged 29-51 years) showed a SLAP lesion (once case each of types II, III, and IV) as a cause of posterior instability. All three patients had a history of a fall on the outstretched arm. All patients underwent arthroscopic refixation of the labrum. After arthroscopic refixation of the SLAP lesions, two patients were completely stable (SLAP II and III), whereas one patient (SLAP IV) reported microinstability during overhead activity but complete stability during activity of daily living. The same patient complained about moderate pain in extreme external-flexion rotation with slightly reduced range of motion in external-flexion position. All other patients were free of pain and showed free range of motion. Our results demonstrate that SLAP lesions can be a cause for posterior shoulder instability. In our cases, posterior shoulder instability caused by SLAP lesions was successfully treated by arthroscopic refixation of the torn biceps anchor. When treating posterior shoulder instability, SLAP lesions should be taken into account.
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PMID:[SLAP lesions as a cause of posterior instability]. 1288 65

Ganglion cysts of the shoulder and concomitant suprascapular nerve compression should be considered in the differential diagnosis of shoulder pain. They are associated commonly with labral tears, most commonly SLAP lesions. MRI has become commonplace in evaluating shoulder pain and has led to the increased awareness of shoulder cysts. MRI accurately demonstrates the size and location of ganglions, which is critical when planning surgical intervention. It also has shown the frequent association of intra-articular pathology with these cysts. Despite that MRI can detect atrophy, the diagnosis of suprascapular nerve compression can be confirmed only by EMG/NCS, because the presence of a cyst does not necessarily mean the nerve is compressed. Likewise, a positive EMG does not confirm that the compression is caused by a ganglion cyst. EMG/NCVs are necessary for confirming the diagnosis and evaluating nerve and muscle function. A trial of nonoperative management is warranted; however, this is associated with a high failure rate. Aspiration techniques are successful for decompression of the cysts and initial pain relief; however, the intra-articular pathology is not addressed and there is a higher rate of recurrence. Open resection of the ganglion cyst is successful; however, the intra-articular labral tears are not addressed, which can lead to recurrence and the morbidity of the cyst excision is not warranted. Shoulder arthroscopy has led to the identification of associated intra-articular pathology such as SLAP lesions. These were not appreciated previously with open surgery and therefore were not addressed. Arthroscopic techniques have evolved to allow decompression of the ganglion cysts and repair of the labral lesions. This should decrease the possibility of recurrence of the cyst by eliminating the cyst and the pathologic lesion that created it. Arthroscopic excision also avoids much of the morbidity of the open approach and allows intra-articular pathology to be addressed concomitantly. This point has been emphasized by other investigators also. Furthermore, because of the limited surgical dissection, rehabilitation is able to begin earlier, with less patient discomfort and more prompt return to normal activities.
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PMID:Ganglion cysts of the shoulder: technique of arthroscopic decompression and fixation of associated type II superior labral anterior to posterior lesions. 1498 91

Shoulder instability is a common clinical feature leading to recurrent pain and limited range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging.
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PMID:[Shoulder instability]. 1515 Jun 45


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