2015 ISAKOS Biennial Congress ePoster #2108
Peel Back Phenomenon of the Superior Labrum of the Shoulder is Dynamic Variant in Arthroscopic Examination
Yusuke Iwahori, MD, PhD, Prof., Kasugai, Aichi-Ken JAPAN
Hirokatsu Hanamura, MD, Kasugai, Aichi-ken JAPAN
Yukihiro Kajita, MD, Ichinomiyashi, Aichi-ken JAPAN
Takayasu Ito, MD, Nagoya, Aichi JAPAN
Keiji Sato, MD, Nagakute, Aichi-ken JAPAN
Department of Orthopaedic Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, JAPAN
FDA Status Cleared
Summary: PBP existed irrespective of superior labral lesion, posterior tightness, and anterior instability of the shoulder.
Abstract:
Purpose
There are some papers indicating that peel back phenomenon of the superior labrum of the shoulder (PBP) is a pathological phenomenon observed especially in throwing shoulder with posterior tightness. However we occasionally find PBP in other conditions. The purpose of this study is to investigate the pathological significance of PBP by arthroscopic dynamic examination.
Methods
We studied prospectively 220 shoulders of 220 patients who underwent arthroscopic surgery. There were 156 male and 64 female patients. There were 20 throwing injuries, 155 anterior instabilities, 37 partial thickness tears of the rotator cuff, and 8 subacromial impingement syndrome. The average age at operation was 30.1 years old (range 14-65). Anterior shoulder instability was defined, when the patients had history of initial or recurrent anterior dislocation or/and arthroscopic findings of the IGHL injuries including Bankart lesion. Posterior tightness was evaluated to be positive when internal rotation angle with the arm abducted 90 degrees or with the arm flexed 90 degrees decreased over 20 degrees comparing with the opposite arm under general anesthesia. The type of SLAP lesion (type I, II, III, and IV), the grade of displaceability of the superior labrum by probing (-, ±, +, and 2+) ,and the grade of PBP (-, ±, +, and 2+ ) with shoulder abduction and external rotation simulating late cocking position was evaluated arthroscopically. The relationships between PBP and anterior instability, posterior tightness, SLAP lesion, dispaceability of the superior labrum were investigated statistically using Chi-square test. The level of statistical significance was set at p < 0.05.
Results
One hundred fifty nine cases had anterior instability and 18 cases had posterior tightness. There were 156 shoulders with positive SLAP lesion (type I:88, II:52, III:12, IV:4) and 64 shoulders with negative SLAP lesions. Dispaceability of the superior labrum was observed apparently (grade + and 2+) in 112 shoulders and slightly (grade – and ±) in 108 shoulders. There were 100 shoulders with positive PBP (grade + and 2+) and 120 shoulders with negative PBP (grade - and ±). No significant differences in PBP positive rate were observed with or without anterior instability, posterior tightness, SLAP lesion, and displaceability of the superior labrum.
Conclusion
PBP existed irrespective of superior labral lesion, posterior tightness, and anterior instability of the shoulder. PBP is supposed to be dynamic variant of arthroscopic examination.