From the Guidelines
SLAP lesions and Bankart lesions are distinct shoulder injuries requiring different diagnostic approaches, with MRI arthrogram being the preferred imaging modality for both conditions, as suggested by the American College of Radiology 1. When differentiating between SLAP and Bankart lesions, it is essential to consider the location and mechanism of injury. SLAP lesions involve damage to the superior labrum, typically caused by overhead activities or falls on an outstretched arm, and are characterized by deep shoulder pain, clicking, and popping. In contrast, Bankart lesions affect the anterior-inferior labrum and are commonly associated with anterior shoulder dislocations, causing instability, apprehension, and recurrent dislocations.
Diagnostic Approach
The diagnostic approach for both conditions involves clinical examination and imaging. According to the American College of Radiology, when radiographs show a fracture of the humeral head or neck, CT without IV contrast is the most appropriate study for characterizing the fracture planes 1. However, for labroligamentous injuries, such as SLAP and Bankart lesions, MRI shoulder without IV contrast or MR arthrography are both appropriate studies 1. CT arthrography is also a viable option, although it has been shown to be inferior to MR arthrography in diagnosing partial-thickness rotator cuff tears 1.
Treatment
Treatment for SLAP and Bankart lesions depends on the severity of the injury. Conservative approaches, including physical therapy, may be sufficient for mild cases. However, more severe or persistent cases may require arthroscopic repair. The key distinction between SLAP and Bankart lesions lies in their location and mechanism of injury, with SLAP lesions occurring superiorly at the biceps anchor and Bankart lesions occurring anteriorly-inferiorly following dislocation events.
Some key points to consider when differentiating between SLAP and Bankart lesions include:
- Location of the injury: SLAP lesions occur superiorly, while Bankart lesions occur anteriorly-inferiorly
- Mechanism of injury: SLAP lesions are typically caused by overhead activities or falls, while Bankart lesions are associated with anterior shoulder dislocations
- Symptoms: SLAP lesions cause deep shoulder pain, clicking, and popping, while Bankart lesions cause instability, apprehension, and recurrent dislocations
- Imaging modality: MRI arthrogram is the preferred imaging modality for both conditions, as suggested by the American College of Radiology 1
From the Research
SLAP Lesion vs Bankart Lesion
- A SLAP lesion is a type of shoulder injury that occurs when the superior labrum, a ring of cartilage that surrounds the socket of the shoulder joint, is torn 2.
- A Bankart lesion, on the other hand, is a type of shoulder injury that occurs when the anterior labrum, a ring of cartilage that surrounds the socket of the shoulder joint, is torn 3.
- Both SLAP and Bankart lesions can cause significant pain and disability, and can be challenging to diagnose and treat 2, 3.
Treatment Options
- Nonoperative management, including rest, physical therapy, and injections, is often the first-line treatment for SLAP lesions, especially in young, active patients without a history of trauma or mechanical symptoms 2.
- Operative treatment, including arthroscopic repair or biceps tenodesis, may be necessary for patients who do not respond to nonoperative management or who have persistent symptoms that prevent them from participating in sports or daily activities 2, 3.
- For Bankart lesions, arthroscopic repair is often the treatment of choice, especially in patients with recurrent shoulder dislocations 4, 5.
- Combined Bankart and SLAP repair may be necessary in some cases, especially in patients with anterior shoulder instability and a coexisting SLAP lesion 4, 5, 6.
Outcomes
- Studies have shown that arthroscopic repair of SLAP lesions can be effective in improving symptoms and function, especially in young athletes 2, 3.
- Combined Bankart and SLAP repair has been shown to be a viable option for patients with anterior shoulder instability and a coexisting SLAP lesion, with similar outcomes to isolated Bankart repair 5, 6.
- Patient-reported outcome measurements, such as the American Shoulder and Elbow Surgeons Score and the Disabilities of the Arm, Shoulder, and Hand Score, can be used to evaluate the effectiveness of treatment for SLAP and Bankart lesions 6.