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I know that we are notoriously unreliable in assigning the Type of SLAP lesion, but I want to clarify what I’m seeing here.
There is a SLAP tear, and it seems to extend posteriorly, but I think the Biceps anchor is intact (do you agree?).
Would this be a bucket handle type tear?
I never call this, but I think there is anterior extension into the rotator interval (do you agree?)
And there is a contiguous chondral defect at the anterior glenoid rim at the chondrolabral junction at 3:00….which supports my impression that here is real anterior extension through and beyond the RI…agree?
I have found this a very informative exercise which has reinforced the concept that no two MSK radiologists will report a SLAP lesion in exactly the same way.
We cannot even agree on whether this affects or spares the Biceps anchor, and certainly cannot agree whether it extends into the rotator interval.
MOST of us agree it is a Bucket Handle type tear.
It might be News to some of us that shoulder surgeons are doing far fewer SLAP repairs than they did a few years ago. The surgical consensus is that the repairs leave the patients stiff….so it is reserved for high performance athletes and quite unstable shoulders (as I understand it).
So, while we scratch our heads and struggle to get the SLAP type “right”, the surgeons aren’t necessarily believing what we say or acting on it as we might expect.
That said, the responses included:
1. If the base of the labrum is torn off then it would be detached. I think it looks like a bucket handle because on one image there seems to be a tiny bit of labrum still attached to the supraglenoid tubercle so it looks like a little bucket fragment. But there are some images where it looks detached off. I don’t think a free flap fragment (like type 6). I know for sure sure the surgeons I work with would call it detached, therefore unstable.
2. Bucket handle with extension into the rotator interval/SGHL. But I think there is involvement of the anchor but not extension into the biceps tendon.
3. based on images (and I always prefer scrolling through the whole study) it could the dreaded Snyder type III “bucket handle tear” of the superior labrum _+/- extension anteriorly
4. My opinion is you may be dealing with a Buford complex with a slap lesion. intact biceps anchor posteriorly. Whether it’s a SLAP type 3 or not – maybe, since they’re often none displaced /reduced with arthrography it can be a difficult call.
5. Thank you for that info and additional images, based on all that I agree with you, it’s a SLAP tear involving the root of the SGHL and extending into the rotator interval, hence a SLAP X? Agree with no involvement of the LHBT anchor and I do not see a definite bucket handle component but I may be wrong…
6. I would call this a bucket handle tear and yes, I agree that the tear is more extensive extending to the inferior labrum
7. I’d call this SLAP III (bucket handle). The anchor is predominantly intact.
8. I agree with you about the bucket handle type tear in the superior labrum.
Biceps is ok.
Just with these images I am having a hard time deciding if there is a rotator interval extension.
About the lesion at 3 o’clock, I am inclined to call it and tear or a fissure at the chondrolabral junction of the anterior labrum.
And from our Shoulder Surgeon friends:
1. I agree but it probably is a type 3 nondisplaced bucket handle. Definitely extends posteriorly. Calling the anterior extension is pretty unreliable because most of the time I find normal variants at the anterosuperior quadrant at surgery.
As for how he would treat?
Depends on symptoms and exam. If really positive I would debride the flap and tenodese the biceps
2. I really can’t assess anything without the physical exam component and knowing something about the patient and his sports activity. I can tell you I have only done 2 SLAP repairs this year….have really cut back dramatically on the SLAP repairs because of the post-op stiffness. I have Never seen a SLAP extend into the rotator interval. I don’t doubt that has been published and reported in meetings, but it is not something we see.
***Respondent #5 asked about injection approach (I did not inject this…I am only injecting arthos under US guidance these days as –most importantly- I prefer it for so many reasons, primarily that I can see the needle tip, and -practically- I am only currently on site at a location with US rather than fluoro). As an aside, when I inject under fluoro, I am the oddball who far prefers the posterior approach…..I have rarely used the RI approach under duress when I was required to fall in lockstep with my colleagues. I don’t like it.
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