الفهرس 
Arthroscopic anatomy of the glenohumeral joint.Only 14 pages are availabe for public view
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Abstract
The glenoid labrum is a triangular fibrocartilaginous structure that serves to deepen the glenoid. While tears of the anteroinferior labrum have long been known to be associated with significant shoulder pathology, injuries of the superior labrum have really only been appreciated as a potential pathological lesion since the advent of shoulder arthroscopy. (Nam and Snyder, 2003)
The superior labrum often has a more meniscoid attachment to the glenoid rim compared with the remainder of the labrum and therefore may be more susceptible to both degenerative as well as traumatic lesions. It also serves as part of the origin of the long head of the biceps. (Vangsness, et al 1994)
Injuries to the superior labral biceps complex can compromise the biceps anchor. Furthermore, the repetitive tensile force exerted by the biceps on the superior labrum likely contributes to poor healing of superior labral tears. (Rodosky, et al 1994)
In 1990, Snyder et al coined the term SLAP (superior labrum, anterior and posterior) lesion to describe a more extensive injury. A SLAP lesion as described by Snyder involves a tear of the superior labrum, which starts posteriorly and extends anteriorly to include the anchor of the biceps tendon to the superior labrum.
Snydyer classified SlAP lesion into 4 types:
1- Type I : Fraying of the superior labrum
2- Type II : Fraying of the superior labrum and detachment of the biceps anchor from the superior glenoid tubercle
3- Type III : Bucket handle tear of the superior labrum
4- Type IV : Bucket handle tear of the superior labrum with extension of the tear into the biceps tendon.
Identification of this lesion starts with a complete history regarding the injured shoulder, including remote trauma; initially, these tears may go unrecognized or may be attributed simply to various non-specific diagnoses such as bursitis.
The patient usually gives history of pain, instability or weakness. And on examination Speed test and O’Brien sign are usually positive. (Nam and Snyder, 2003)
SLAP lesion must be differentiated from other causes of shoulder pain such as biceps tendonitis, acromio-clavicular joint derangement calcific tendinits, frozen shoulder, glenohumeral arthritis, coracoid impingement and cervical disc. ( Rockwood & Matsen, 2000)
Investigations include plain radiography to exclude any associated pathology. But MRI and MRI arthrography are more important in diagnosis of SLAP lesion and assessment of other soft tissue structure of the shoulder ( rotator cuff, labrum, biceps tendon, and joint capsule).(Bencardino et al, 2000)
Initial treatment of suspected SLAP lesions should be nonoperative. Emphasis should be on rest, capsular stretching, and physical therapy focusing on rotator cuff and scapula stabilizer strengthening may be helpful.
The use of shoulder arthroscopy as a diagnostic and therapeutic tool is advocated. Patients who demonstrate symptoms and physical findings consistent with SLAP lesions but do not show a lesion with imaging may require shoulder arthroscopy to confirm diagnosis. (Resch, 1993)
Once the presence of a SLAP lesion is confirmed, operative intervention can be made, depending upon morphology of the lesion. Intervention varies from arthroscopic debridement to fixation using bioabsorbable anchors. (Nam and Snyder, 2003)
There are different types of fixation devices used in management of SLAP lesion including :
1- Sutures which attached to bone by drilling one or more holes through the bone.
2- Metallic staples and screws. They have a high rate of loosening and becoming intra-articular bodies resulting in articular damage.
3- Suture anchors either pound-in or screw-in anchors. They are made of three different types of materials ( metal, plastic, and bioabsorbable.)
4- Bioabsorbable tacks.(Snyder, 2003)
Postoperative rehabilitation program should start immediately after surgery. The shoulder is immobilized in a sling for 3-4 weeks. After that gradual range of motion exercise started for another 10 weeks.
Patient can return to sport 4-6 weeks postoperative. (Ciullo, 1996)
Appropriate operative management of SLAP lesions gives both recreational and high-level overhead athletes the best chance at an unlimited return to sporting activities. (Nam and Snyder, 2003)
Complication of arthroscopic repair of SLAP lesion include the general complications of shoulder arthroscopy which include ( Neurological complication of the brachia plexus, complication during portal placement, hypotension, infection and equipment failure.) .(Rockwood & Matsen, 2000)