Consider nonoperative treatment to effectively manage superior labral lesions

Nearly all overhead-sport athletes in study could return to their activity following conservative care.

SAN FRANCISCO — Mid-term results from a new study suggest patients with superior labral lesions, particularly isolated ones, may successfully gain pain relief and return to function just by undergoing nonoperative treatment.

"American Shoulder and Elbow Surgeons (ASES) scores improved with these patients," said Sara L. Edwards, MD, who presented results of the 18-patient retrospective study during the Arthroscopy Association of North American 26th Annual Meeting, here.

Similarly, results of other outcome assessment scores like the Simple Shoulder Test (SST) and Visual Analog Scale (VAS) also reflected the improvements investigators saw in patients with superior labrum anterior-posterior (SLAP) lesions, she said. Instead of surgery, they underwent various physical therapy regimens and took anti-inflammatory medications.

All the patients were recreational athletes; 13 were overhead athletes who swam or played sports such as tennis, squash and racquetball. Twelve of them returned to overhead sports after treatment, Edwards said.

Scores reflect effect

"There appears to be a subset of patients with clinically isolated SLAP lesions who respond to nonoperative treatment based on improvement of their validated outcome scores," Edwards said. "Based on these data, we feel that a trial of nonoperative treatment should be considered in patients with isolated SLAP lesions."

Of 371 patients treated for SLAP lesions from 2000 to 2005 at Columbia University Medical Center, New York, 19 patients treated nonoperatively reached the 1-year minimum follow-up and completed the appropriate outcomes assessments for inclusion (17 men; average age, 35 years). The average length of follow-up was 3.1 years.

The physical therapy portion of their nonoperative treatment consisted of an average of 17 physical therapy visits focusing on capsular stretching and scapular stabilization. "All patients were treated with anti-inflammatories," Edwards noted.

Pain and function improve

Compared to pretreatment values, the patients' function improved significantly at the latest follow-up. Average ASES scores improved from 58.5 to 85.9 points (P<.001) and SST scores improved from 8.3 to 11.1 points (P<.05). "VAS pain scores decreased significantly from 4.6 to 1.9 (P<.05)," Edwards said.

The patients' average pretreatment EuroQoL scores also improved to 0.9 points at the minimum follow-up.

Afterwards, all patients returned to recreational sports but three did not return to their pre-injury level of play, including two of the overhead athletes.

The study's weak points: It was retrospective, and the physical therapy and anti-inflammatory treatments varied, according to Edwards.

In order to identify appropriate patients for this study, investigators used tests that best correlated with a SLAP lesion, like MRI, magnetic resonance arthrograms and positive O'Brien's tests, Edwards said during the discussion period.

For more information:
Sara L. Edwards, MD, can be reached at Oakland Bone & Joint Specialists, 80 Grand Ave., suite 500, Oakland, CA 94612. (510) 451-6266; e-mail: saraedwards1@gmail.com. She indicated she no financial conflicts to disclose.
Blaine TA, Edwards SL, Lee JA, et al. Improved outcomes with non-operative treatment of superior labral tears. #SS-53. Presented at the Arthroscopy Association of North America 26th Annual Meeting. April 26-29, 2007. San Francisco.