Edwards, Am J Sports Med 2010 - Nonoperative Treatment of Superior Labrum Anterior Posterior Tears: Improvements in Pain, Function, and Quality of Life - Article Summary

Nonoperative Treatment of Superior Labrum Anterior Posterior Tears: Improvements in Pain, Function, and Quality of Life

Edwards, Blaine, et al.·Am J Sports Med·2010·175 citations·Case series

Background

Although there are multiple reports documenting successful outcomes with operative treatment of superior labrum anterior posterior (SLAP) tears, there are few reports on the results of nonoperative treatment.

Purpose

Hypothesis: Nonoperative treatment of SLAP tears will result in improved outcomes over pretreatment values using validated, patient-derived outcome instruments.

Methods

Study Design: Case series; Level of evidence, 4.

A total of 371 patients with a diagnosis of labral tear at our institution were mailed a questionnaire that included the following validated, patient-derived outcome assessment instruments: Short Form 36 (SF-36), European Quality of Life measure (EuroQol), visual analog pain scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and simple shoulder test (SST).
66 surveys did not reach the patients because of incorrect addresses, and 50 surveys were returned, for a 16.4% (50 of 305) response rate.
Of the patients with a clinically documented SLAP lesion (positive O'Brien test, pain at the bicipital groove, and positive magnetic resonance imaging) and sufficient follow-up data (minimum 1 year), 39 patients who met the criteria returned the survey and 19 had nonoperative treatment.
20 patients (51%) from the overall surveyed group were considered nonoperative treatment failures and had arthroscopic surgical reconstruction.
Nonoperative treatment consisted of nonsteroidal anti-inflammatory drugs and a physical therapy protocol focused on scapular stabilization exercises and posterior capsular stretching.
Statistical analysis was performed using the paired t test; values of P < .05 were considered significant.

Results

At an average follow-up of 3.1 years, function improved significantly (ASES function 30.8 to 45.0 [P < .001]; ASES total 58.5 to 84.7 [P = .001], SST 8.3 to 11.0 [P = .02]) in those patients with successful nonoperative treatment.
Quality of life also improved after treatment (EuroQol 0.76 to 0.89, P = .009).
Pain relief was significant, as VAS pain scores decreased from 4.5 to 2.1 (P = .043).
All patients with successful nonoperative treatment returned to sports.
71 percent of all athletes were able to return to preparticipation levels, but only 66% of overhead athletes returned to their sport at the same or higher level.

Conclusions

Using validated, patient-derived outcome instruments, the present study shows that successful nonoperative treatment of superior labral tears results in improved pain relief and functional outcomes compared with pretreatment assessments.

Supplemental

Nonoperative Treatment of Superior Labrum Anterior Posterior Tears: Improvements in Pain, Function, and Quality of Life.

Edwards, Blaine, et al.Am J Sports Med2010175 citationsCase series