Andrews et al. arthroscopically examined 73 throwing athletes to determine whether the long head of the biceps causes glenoid labrum tears during throwing. The study combined arthroscopic observation, intraoperative electrical muscle stimulation, and 3D high-speed cinematography to test this hypothesis. This is the foundational paper establishing the biceps-labrum complex as a distinct injury entity in overhead athletes.
When a pitcher presents with anterosuperior shoulder pain and a clunk with the arm in full abduction and flexion near the ear, the diagnosis is biceps-labrum complex injury — not instability, not Bankart.
Before this paper, labral pathology in young throwers without dislocation rarely entered the differential for shoulder pain. The accepted framework linked labral tears almost exclusively to Bankart lesions from instability events or degenerative disease in older patients.
The operative distinction matters. These anterosuperior tears produce a sensation of instability without anatomic instability. Extending the debridement to the anteroinferior labrum can precipitate true dislocation. Counsel patients explicitly before surgery.
This paper is the direct conceptual predecessor to Snyder's 1990 SLAP classification. Andrews identified the lesion and proposed the biceps-traction mechanism; Snyder gave it the name and staging system that became the operative framework still in use today.
Andrews et al. arthroscopically examined 73 throwing athletes to determine whether the long head of the biceps causes glenoid labrum tears during throwing. The study combined arthroscopic observation, intraoperative electrical muscle stimulation, and 3D high-speed cinematography to test this hypothesis. This is the foundational paper establishing the biceps-labrum complex as a distinct injury entity in overhead athletes.
When a pitcher presents with anterosuperior shoulder pain and a clunk with the arm in full abduction and flexion near the ear, the diagnosis is biceps-labrum complex injury — not instability, not Bankart.
Before this paper, labral pathology in young throwers without dislocation rarely entered the differential for shoulder pain. The accepted framework linked labral tears almost exclusively to Bankart lesions from instability events or degenerative disease in older patients.
The operative distinction matters. These anterosuperior tears produce a sensation of instability without anatomic instability. Extending the debridement to the anteroinferior labrum can precipitate true dislocation. Counsel patients explicitly before surgery.
This paper is the direct conceptual predecessor to Snyder's 1990 SLAP classification. Andrews identified the lesion and proposed the biceps-traction mechanism; Snyder gave it the name and staging system that became the operative framework still in use today.