Superior Labral Anterior Posterior Tears | Everything you need to know about SLAP tears!
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- Опубліковано 25 чер 2024
- In this educational video we take you through what SLAP tears are using our 3D anatomy model, explore mechanisms of injury, discuss how SLAP tears are managed and how Physio rehab can help.
References:
Scott E. Powell, Keith D. Nord, Richard K.N. Ryu. (2012). The Diagnosis, Classification, and Treatment of SLAP Lesions, Operative Techniques in Sports Medicine, Volume 20, Issue 1, Pages 46-56. doi.org/10.1053/j.otsm.2012.0...
Clark, R. C., Chandler, C. C., Fuqua, A. C., Glymph, K. N., Lambert, G. C., & Rigney, K. J. (2019). USE of CLINICAL TEST CLUSTERS VERSUS ADVANCED IMAGING STUDIES in the MANAGEMENT of PATIENTS with a SUSPECTED SLAP TEAR. International journal of sports physical therapy, 14(3), 345-352. doi.org/10.26603/ijspt20190345
Papadopoulos Pericles, Karataglis Dimitrios, Boutsiadis Achilleas, Charistos Stavros, Katranitsa Lamprini, and Christodoulou Anastasios. (2012). SLAP LESIONS. EPIDEMIOLOGICAL STUDY, Orthopaedic Proceedings 2012 94-B:SUPP_XXXVII, 558-558
Ahsan, Z. S., Hsu, J. E., & Gee, A. O. (2016). The Snyder Classification of Superior Labrum Anterior and Posterior (SLAP) Lesions. Clinical orthopaedics and related research, 474(9), 2075-2078. doi.org/10.1007/s11999-016-48...
Brockmeyer M, Tompkins M, Kohn DM, Lorbach O. (2016). SLAP lesions: a treatment algorithm. Knee Surg Sports Traumatol Arthrosc;24(2):447-55.
doi.org/10.1007/s00167-015-39...
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As someone in PT school, I can’t believe I just discovered this channel. It’s a life saver! Thank you!!
Dude, you are an incredible teacher! I'm a long time athlete who played at pretty high levels and you explained these details better than any of the trainers I had in my career. Thank you!
Thank you so much John-Carlos! That’s very kind of you 🙏🏼 Hope we can keep helping you!
😂
Thank you so much for the detailed explanations, along with the evidence-based findings!
You’re very welcome!
Thank you for the detailed video with the visual representations. Your video was much more useful than any other videos out there. Please continue your great work.
Glad it was helpful! Kusunum Balázs!
Thank you. Rare to get quality posts like yours.
Thank you so much for your kind words!
This was a great breakdown as I just discovered this morning that I have a slap lesion tear thank you for making it so simple to understand
Thoroughly and engagingly explained! Thank you!
You’re very welcome!
You have the gift of teaching. Very structured thinking.
Thank you so much!
As a very new physio still trying to put everything together, your videos are an absolute life-line. Thank you so so much for taking the time to make them!!!
You’re so welcome Rebecca! I’m so glad you are enjoying them! We have loads as well on instagram @clinicalphysio if you want to follow us there!
Most helpful video on this subject I've seen to this point---thanks!
Thank you so much!
Awesome video, people pay for this level of education, thanks for delivering such a great lecture!
Thank you so much Adam that’s very kind of you!
جزاك الله خيرا دكتور خالد
I'd like to thank you from the bottom of my heart for your wonderful videos. I had an MSK exam today, and because of your content, I was able to pass. MSK is my weakest subject and has been a major source of anxiety for me, but everything you release is so easy to disseminate. I was given a shoulder scenario where I had a SLAP tear as my differential and was able to talk at length about it thanks to you. You're an absolute star, and I hope this channel continues to grow.
Congratulations Lisha!! This is absolutely wonderful news and I’m so pleased to hear how well you did! Huge credit to you and we are very grateful to have played a small part in your journey! Well done!!
thanks for the video, it is very informative without being too technical. I will pass this on to patients suffering from a SLAP lesion.
Thank you so much Dr!
My compliments Sir 👏 Not only are you knowledgeable, but you also know how to teach and explain. A very rare combination. Once again, well done 👍
So nice of you! Thank you for watching!
Fantastic video and great review.
Thank you so much! Very kind words!
Excellent explanations and appreciate the references to academic papers.
Glad it was helpful! Thank you for watching!
Great video for revision. Your condition specific n differential diagnosis video are really helpful.
You’re very welcome! Thank you for watching!
Thank you for the great video! I just had our athletics PT tell me I injured my labrum and gave me most of the exercises to do that were listed here. This video helped me understand and made me feel a lot better about it.
🙏🏼🙏🏼🙏🏼 very kind thank you!
Is surgery required?
Awesome information. Currently working on my third rotator cuff surgery.
Thank you so much for your kind words! Wish you all the best with your surgery!
Fantastic video, thankyou so much. I've had this for 10yrs, and only one dr is now diagnosing it. Have always been told it's impingement.
🙏🏼🙏🏼🙏🏼 wish you all the best!
Very informative! Thank you so much!!
You’re very welcome!
Much Gratitude
Thank you so much! Glad you enjoyed it!
Wow, these videos are so good. Thank you for sharing
You are so welcome! Thank you so much for your kind words!
Great video you are very articulate. I'm a young athlete who's experienced dull but deep shoulder pain for almost two years. It has prevented me from playing tennis and other shoulder intensive activities in any significant capacity. I am excited to start my journey to repairing my shoulder.
Thank you so much John! Wishing you all the best in your recovery!
Wow! Awesome breakdown. Articulate, precise and very easy to understand. Subbed immediately.
Just what I needed after my type 2 SLAP Tear and biceps tendinitis diagnosis today!
Thank you so much! Wish you all the best!
How are you now?
THE most comprehensive video on SLAP tears I've seen to date. You've reassured me that there are things I can do whilst awaiting further diagnosis. Thank you so much!
Thank you so much for your kind words my friend!
Is surgery required?
Turned out to be an issue with the biceps tendon which I've managed through physio.
This lecture was really really informative 😃 Thank you so much 😊😊
Most welcome 😊 thank you for watching!
Brilliant channel.
Thank you so much!
Thank you for the video. I appreciate your time and effort putting into these videos. I recently have been reading some studies as they relate to the treatment of SLAP tears. There was a small RTC study using bone marrow concentrate (BMC) and platelet-rich plasma (PRP) as a treatment modality. It's potentially a safer and more robust way to address the injury compared to the standard treatment we currently offer.
Thank you so much for your messages and interesting to hear about these options!
12-14-22. Best vid so far!! Mot my injury but very informative!! and EXCELLENT SPEACH with fantastic explanations!!
Had stage 3 Acronium separation!
Surgeon was worthless-physio people WERE WORTHLESS!!
Can’t anyone DO ANYTHING CORRECT!!??
Thanks for a good vid!
Thank you so much my friend for your kind words! Wish you all the best with your shoulder 🙏🏼
Just got my MRI indicating Superior labral tear, extending into anterior labrum.
Thank you for the neat explanation! 🙏🏼
i just got today my mri scan same as you superior labral tear how is your shoulder now?
@@mustimustafa3759did you get into PT?
@@mustimustafa3759Is surgery required?
Keep Going Khalid One of my favorite Physio Channel.
Thank you so much for your kind words!
Great Great Video! Thank you 🙏
Thank you so much for watching
Thank you Khalid
You are the best 😇
Thank you so much for your kind words!
Great stuff. Thanks.
Glad you enjoyed it! Thank you!
Thank you for this
You are very welcome!
Really excellent
Thanks a lot! Very kind of you!
Great informative video.
Thank you so much!
Best explanation I’ve come across. I don’t have an official diagnosis yet as my mri is in several weeks, but I’m in agony. Suffering since October. Can barely move my arm. It feels as tho it’s coming off of my body when I do move it. I can feel it subluxing 😢 lots of expletives to describe it but I never fell on it extended. I did however slam right in it from falling on ice about 12 years ago. Went to PT then and it healed nicely. Didn’t have any tears back then. This is awful and I’m going out of my mind. Interrupted sleep… tried PT and can’t do it. I do not know what I did. Just woke up in pain. And it hasn’t stopped.
Brilliant!
Thank you so much!
Thank you!
Thank you so much!
thank you, very helpful video 👏
You're welcome!
Really good video. Thank you
Thank you so much!
great information
Thank you so much!
Very well presented!
Thank you so much!
Thank you.
You’re very welcome!
Hi,I've had an X-ray and ultrasound of my right shoulder, then 12 months later, a mri the ultrasound showed two small tears in my rotator cuff however did pick up a labral slap tear until i had the mri scan done then the slap tear was seen so I have type 3 tear. I've had symptoms over the past 15 months, and I've gradually gotten worse. I've had rotator cuff repair on my left shoulder, too.
I've been doing exercise physiotherapy since surgery back in February 2022 and before that and developed capsulitis, which has put recovery back a bit. However, now the right shoulder issue my specialist surgeon has recommended surgery to repair the labram. However, the bicep tendinitis, hasn't been mentioned when I've spoken to my surgeon, so I'll definitely talk to my doctor about this. Your video explains this quite clearly. Oh, and my background. I'm 51 and have been working in a truck parts warehouse for the past 20 years now, and there's a lot of heavy repeative lifting.
Great video cheers, Col 👍
Geez, so in-depth, but also digestible and easily applied. Out of all the tests, I had no pain, though I still have rear delt pinching after a meso of upper body training. I'm going to work with the suggested band exercises at the end of the video. Thanks for your help!
Thank you so much for your kind words!
@@ClinicalPhysio Anytime.
what do you mean by rear delt pinching?
@@sonic-fm1gw sharp muscle pain in rear delt in abduction
Amazing Video, very informative and perfectively presented. Love it. (Just had a SLAP repair myself, 8 weeks post surgery)
Thank you Rob! Wish you all the best for your recovery!
Is the operation laparoscopic?
Great video
Thank you so much!
Wow, good lecture.👌
Thank you so much!
What an incredible and clear description!! Subscribe!
Thank you so much!
Informative. Nice video :)
Thank you so much!
Excellent video! Very thorough, very clear, evidence based, very well explained.
Glad you liked it! Thank you so much!
Thank you so much....such a great video.....I love Clinical Physio.....can you pls make some videos on lumbar / thoracic / cervical spine....I have some difficulties to really understand some of the nerve related pathologies and how to gradually treat/mobilize them right.....that would be so cool.....
Hi! Thank you so much for your message! Absolutely we have lots of assessment videos on this in our UA-cam channel, but also we have LOTS of webinars on our website at clinicalphysio.com with even more info on those kind of subjects and more!
i give this lesson a 10/10!
Thank you so much for your kind words!
what do you think about the recent studies that came out explaining how the labrum has a rich blood supply?shouldnt this result in a greater healing capability?@@ClinicalPhysio
Wow, this video is such a great help and so informative. Thanks a lot. At least I have no problems with the first two biceps exercises, but pain within the third test. But the other way round, no pain while thumb goes down, but deep pain, while palms show up. 🤷🏻♂️
And also deep pain while reaching the arm in front and than rotating it in both directions like holding a bottle and kipping it out and than turning in the other direction.
You’re very welcome! Wishing you all the very best with your shoulder 🙏🏼
What a fantastic video, Khalid, thank you!! After over-use at the gym (likely doing Arnie presses!) 6 months ago, and ignoring it, I was recently diagnosed with SLAP lesion by my orthopedic surgeon and had many visits at my physio. After about 6 weeks (and prescription anti-inflammatories), the constant pain has been slowly subsiding - but every now and then it will flare up again. I'm 40.
One thing I noticed was the three preferred tests for high degrees of diagnosis. In each of them (except the supinated O'Briens test) I felt almost no discomfort (like 1 out of 10). MRI however has shown it as a slap lesion - Type 1 or 2, the doctor said. I will be going in for a contrast MRI to better show any lesion in the area. My strong preference is not to get surgery, so I'm trying to rehab as much as possible.
I'd love to get any further recommendations for rehab exercises (including good form) that you can think of. I often find myself needing to mentally engage the right muscles as using the resistance bands sometimes causes me to just use my bicep/tricep instead of posterior rotator cuff.
Once again thank you so much for this video, it really helps spread the knowledge and clearly articulates the terminology!
Hi Mark! Thank you so much for your message! I’m really pleased to hear that all tests gave almost no discomfort! I must admit I would be a hypocrite if I was to give clear advice over the internet as a therapist/doctor/clinician who is able to see you in person and assess you is much better than me guessing over messaging… but a few things to think about, 1) SLAP lesion on a scan can be an incidental finding I.E. it is on the scan, but is it actually causing the symptoms?…… 2) You can absolutely avoid surgery if you it isn’t causing a huge issue to you and your pain levels ….. 3) once again, to prevent hypocrisy, please may I recommend you get specific exercise advice from someone who can fully assess you for the right exercises. Sorry to not give specific advice, but I would much prefer, for your sake, that you get advice specifically from someone who can assess you rather than me guessing at exercises over the internet 🙏🏼 wish you all the best!
@@ClinicalPhysio is the superior and posterior labrum at the posterosuperior aspect of the humerus? what are the structures commonly involved there?
also what are the symptoms the slap should be producing?
Sir excellent 👍
Thank you so much!
Cheers man, great teacher. Helped me understand what my specialist was saying lol.
You’re very welcome! Thank you so much for watching!
Nice video 🎉
Thank you so much!
Thank you.this is very good!
Thank you so much!
This vid is amazing 👏
Thanku sir 🙏 👍
Most welcome! Thank you!
Thank you for this throughout explanation. I suffered a stage 2 SLAP tear to my left shoulder in summer of 2017 from trying to start a VERY stubborn lawnmower. I did some shoulder stretches afterwards to see if it would improve my pain. It only increased my pain by 100%. I felt a spider web of pain to the front of my shoulder. Then afterwards I couldn't raise my arm up above my head. I spent 3 months in an arm sling. Every step I took KILLED my shoulder. Riding in a vehicle was also extremely unbearable. I later developed long head bicep tendinitis due to the SLAP tear. I've had nearly 6 years of on and off extreme pain. Then had surgery late January for another issue. It was mandatory that the BP cuff be placed on my left arm dispite my pleas of having bicep tendinitis. My BP was taken 5x that day for surgery. Been living with level 8-10 front shoulder pain since then. Can anyone explain why having a BP taken 5x cause injury to an already damaged and repaired tendon?
Excellent video, any update on the research regarding stem cell therapy for these injuries?
Informative vid!!! Hope you can get to radial head fracture soon!!! Keep it up!!!
Thank you!
Yes radial head fracture would be a great video from this physical therapist!
Great video! Would you ever consider making a video on FAI and labral tear conservative physio management?
Hi Amy! Thank you so much for your message! Yes absolutely, we have a long list of things to do and certainly hip related stuff is one of them!
Thank you for this full explanation 👍 If I understood well, the pain is on shoulder, if I have only pain on the biceps this is probably not a SLAP. I feel pain and weakness on one biceps and after mri the doctor thinks it's a slap tear, I will see a shoulder specialist soon.
Wish you all the best Pedro!
I got a slap tear and can’t get the surgery since I can’t miss the amount of work to recover. The doctor said I could live with it but it was an option. Great video!
Same here
Insane to live in a world where you cant get sick leave to fix a damn shoulder
I can only dream of one day getting my shoulder / arm into the position to even start these 3 tests.
🙏🏼
Hopefully with pt and no surgery I’ll be able to return to volleyball and play professionally, thank you for the information!
Do you suffer from slap?
Big Fan of your Channel Khalid! Kindly make a video on Paediatric MSK conditions..Thanks!
Thank you so much for your kind words! We actually have a full webinar run this month by a specialist orthopaedic consultant and specialist Paeds physio! This can be found at clinicalphysio.com/live-webinars
@@ClinicalPhysio Thanks!
I need your advice :)
A week ago I was doing pec cable flies from slightly below shoulder level, lightweight (12 kg either side) really slowly, controlled, focusing on the stretch.
I was allowing my arms to go back a lot at the end of the eccentric.
And, third set, 12th rep, I heard a subtle pop.
Accompanied by a strange sensation.
Not pain, or very little pain.
It was more like a sensation of ease.
As if my right shoulder joint had found a better location and it could move more freely.
I have always had limited mobility in my right shoulder accompanied by pain both on internal and external rotation limits.
So yes - first I thought it was a “good pop”…
But when it came to train the biceps, I realised a strange gap between my felt and the long head of my biceps.
I could still contract it, but it felt out of place so I stopped. I also noticed a slight yellowing right under my front delt where my bicep used to start, but now there is a slight gap.
Went to emergency room and was told it’s a tear but it would heal on its own.
Dismissed in 10 minutes.
Having replayed it in my mind, what I believe happened, was a shift of the upper tendon. It simply feels as if that long tendon no longer runs in the groove at the top of my humerus, instead it moved a couple of centimetres forward and internally.
What do you think,
And what should I do?
I really want to keep my functionality of my body, you know… I’m quite worried.
Theodor
Thank you for this video! I'm curious, what's the reasoning for the Arnie press?
Oh man, I'm 30 and have been struggling with a bad shoulder for the past 7 years.. had to give up muay thai and cant lift heavy like I used to. Been to some physio and was given some pointers, but over the years I've also explored my body with movement. Some of the movements you recommended I intuitively incorporated, like the straight arm pull down and Arnie press. I also like to lie on my back and with even just 5lb dbs do a lat pull over. But I'm going to I corporate the other motions you suggested, hoping they help!
Wishing you all the best!
man , you know exactly my shoulders problem
🙏🏼
bruh u r way better than my lecturer at uni
Very kind! Thank you!
Thank you, Doc. I passed those tests. This isn't my problem. I think I have bicep's tendinitis
No problem! Wish you all the very best!
Can you make a video on how to understand biomechanics and apply it on patients by showing us the exact mechanism what happens in the body
Thankyou and great videos 🔥
Thank you so much!
I had reparative surgery for this. It was endoscopic. But the imaging was the most painful thing I’ve encountered thus far in my life. The imaging was unbearable the length and positioning they had me in. And the contrast dye seemed like it was making my entire joint expand.
I also had a distal biceps tendon rupture on that same side. It was repaired with an endobutton surgery. This happened before my slap tear.
Now I have awful forearm and hand pain numbness and burning in both hands.
Wishing you all the very best my friend
This was incredibly informative and well done, thank you. What is your opinion on using mesenchymal stem cells for SLAP tears?
Very kind of you! Thank you 🙏🏼 my honest answer is I don’t have much of an opinion on them but I very rarely see this being used in practice, which I suppose just suggests to me that they may not have a lot of evidence behind them
Great video. I’m currently in physical therapy for a suspected slap tear of my left shoulder. What a “wonky” feeling! Clicking and clunking was pretty bad but seems to be lessening with treatment. I’m 52 and pretty active. My biggest concern is the possibility of a full long bicep tendon rupture occurring.
Wishing you all the very best with your physio! One step at a time 🙏🏼
Hello, how is the treatment going?
Hi Doc. Awesome video. I have a question. What about PRP treatment for a grade 1 tear? Thanks
Hi John! Thank you so much for your message… Honest answer I haven’t seen many successful or evidenced based research suggesting that PRP is a good option
Very good😉😉😉
Thank you so much!
Thank you for awesome video! Can you tell me what software you used?
Hi! Yes it was custom made for us by a software developer - we are very grateful to be able to use it!
I'm positive for the first and third test.
New Subscriber!! I was wondering at what stage are PRP Injections beneficial?
Hi! I’m afraid evidence behind PRP can be slightly limited , especially if clear structural changes … But that’s just personal opinion!
I’m really adverse to the western medicine idea or just doing surgery for every injury. Are there any types of treatments like acupuncture or something that have been effective for this injury?
Doc how about nerve entrapment due to slap tear suprascapular nerve
I had a slap tear back in 2012….the Dr did test 1 and then he squeezed my inner arm between my bicep and tricep and the pain completely went away…and he goes “yup gonna need surgery” 😂 good drs are hard to come by but when you find them they are awesome
🙏🏼🙏🏼🙏🏼 Hope You are doing well now
@@ClinicalPhysio he put some new Chinese finger cuff anchors in and my shoulder is doing good.
@@Asymmetrical.athlete_ 👍🏼👍🏼👍🏼
I'm 48 and had SLAP tear surgery in 2009. I was great till about 5 weeks ago my shoulder hurts again and I cannot throw a baseball or football without pain and discomfort and a feeling of disconnect. I've tried ice, a few exercises, 3-5lb dumbbell exercises, resting it....not helping. I need to call the orthopedic that repaired it in 2009. Full recovery took about 2 months which was quick the Dr. claimed.
🙏🏼🙏🏼🙏🏼 wishing you all the best
When did you have surgery after first tear? Mine is chronic. I hate most orthos not even repairing it anymore.
Well, you could always go the route I went. Injured nearly 8 years ago now. Unable to lift a coffee cup up with my dominating arm. Feelings of raking box cutter sessions from the finger tips to the shoulder vice versa. With basic govt health care. Injured on the job, employer admitted no fault. Surgery was a pipe dream, still seems that way. Just soon after I lost my wife and sweet home, thanks to unemployment from the intense pain lifting simple items. She was smart to go. I was angry and didn't like going places with crowds because having someone brush my arm only triggered me. Same day, she left I lost my dog to an over grown and broken heart. Had to start living out of the back of my vintage pickup. 5 years I've lived via long bed now. The transmission just went out on me! Who's got arm I can borrow?
@@batman-sr2px Try PRP threatment...It's great in my case. I'm SLAP typ 2
This is so helpful thank you! Please what would you expect to see during the objective AROM, PROM and resisted tests? Would SLAP patients show weakness or any pain during particular PROM? Thank you
Hi Louisa! If a lower grade then mild restriction in AROM and potentially PROM, and I would expected resisted biceps to be sore. In more higher grades or severe cases I would probably expect more restriction and potential for other resisted tests including rotation to be sore, particularly if rotation is tested in outer ranges 😊 However, there isn’t necessarily a “one size fits all” with this and so would focus on subjective + tests as able 🙏🏼
Thank you for your analytical explanations!
One question: when someone is clinically diagnosed with a slap tear but the MRI doesn't show it, is it possible that this type of tair is type I or II, excluding the types III and IV?
Thank you
Hey thanks for the superb detail.
The start of my shoulder injury started from one tennis session after not playing for a long while. Started booming serves because i just missed it so much haha. Next few days had the normal soreness around the teres area but once that soreness went away, a dull ache kicked in (infra area. Pec area only when i do runs). I reduced my arm activity a lot to not aggravate it but the dull ache continued and I started to notice i get a painful shoulder clunk when i bring my arm down from a fully flexed position (arnold press hurts from end positions to initial). Its been a year already now. Both of that symptoms are still there but with physio i dont limit my arm movement as much anymore and my strength definitely came back. Have yet to take an MRI but do you think the two symptoms i have is related to over doing it on the tennis serves during that session? Technically is not a traumatic one but a tennis serve can be considered traumatic haha. But anyway, just from this explanation alone, do you think there's definietly a tear?
Hi Pascal - to answer your question, “No, I’m not totally convinced you have a SLAP tear”. But also, it’s important for me to say that it’s wrong to give you a diagnosis over the internet… please please seek advice with an assessment with a local clinician so you can get more accurate information 🙏🏼
Great video. Really helpful for the understanding of a SLAP lesion.
Glad you enjoyed it! Thank you so much for your kind words!
You should also screen for Ehlers Danlos with the Beighton score which will increase risk
Great thought!
How long after your injury should you start exercising?
I had an injury wake boarding. Being pulled while my wake board was dragging. I think I over did the bicep muscles. I have been dealing with some pain for 5 months when I finally went in to the doctor to really figure it out. Got an MRI and doctor said I had a SLAP tear. He recommended tenodesis surgery. I basically have full range of motion but I do feel pain in extreme positions and I feel a bit of soreness still on the top of my bicep. Seemingly coming from the tendons. I tried to do the tests you showed on your video to myself and didn't experience pain. After what you stated about MRI tests I'm now a little sceptical that I have a SLAP tear. This injury has been more annoyance with sharp pains but it has gotten better over the 5 months. My surgery is scheduled in 5 days. And now I'm conflicted whether it's necessary. Would you recommend a second opinion or physical therapy before I do the surgery? I tried to do some of my own physical therapy after my injury but never did completely heal. Hard to know what to do.
Hi Doc! Thank you for your informative videos. I study a lot from your channel since all the videos are well explained and easy to understand. From this video about the diagnosis of SLAP lesion, the study said that it is much better to do arthroscopy than MRI (because 87.5% of the cases missed diagnosing SLAP lesion) and the rehab for this depends on the grade of the injury. Since arthroscopy is quite invasive, and from the combination of those 3 special test we can early diagnose the SLAP lesion, I want to ask, is there any signs that we can use to differentiate and predict the grade based on physical examination only? Thank you
Hi Jessy!! Nice question thank you so much! I suppose we are likely to find that your higher grades of SLAP tears are going to be even more symptomatic - but I would suggest a clinician is less likely to be able to say “that’s definitely Grade 3” or that’s definitely “Grade 4” with clinical examination alone. Hope that makes sense 🙏🏼