Burkhart S S, Morgan C D, Kibler W B
Baylor College of Medicine, Houston, Texas, USA.
Clin Sports Med. 2000 Jan;19(1):125-58. doi: 10.1016/s0278-5919(05)70300-8.
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.
2型SLAP损伤存在三种不同类型：（1）前部，（2）后部，以及（3）前后联合型。后部2型SLAP损伤具有独特的临床和解剖特征，使其与前部2型SLAP损伤相区别。后部和联合型2型SLAP损伤对于过头投掷运动员可能会导致功能障碍，因为存在后上不稳定和前下假性松弛。对于后部或前后联合型2型SLAP损伤患者，若Jobe复位试验出现后上疼痛则为阳性，而前部2型SLAP损伤患者该试验为阴性。肩袖撕裂常与后部或前后联合型SLAP损伤相关，具有损伤部位特异性，且通常起始于关节内，为下表面撕裂。修复后部SLAP损伤可使过头投掷运动员恢复完全的过头运动功能。剥离机制可能是后部2型SLAP损伤的原因。为了牢固修复后上盂唇以抵抗扭转剥离，应在肱二头肌后方、肩胛盂角处放置缝线锚钉。修复后必须在3周内防止外旋超过0度，以避免剥离机制对修复造成过度的过早扭转应力。后下关节囊紧张易导致过头运动员发生2型SLAP损伤。存在死臂综合征风险的肩部由于后下关节囊挛缩而导致内旋明显丧失，使得手臂外展90度时旋转弧度小于180度（180度规则）。在过头投掷运动员中导致死臂综合征的2型SLAP损伤最可能是在晚期引臂阶段发生的加速损伤，而非随挥阶段的减速损伤。对死臂综合征运动员的康复治疗必须包括整个动力链。死臂综合征的根本原因是2型SLAP损伤。
