Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life

Abstract

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.

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

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

Methods: 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). Sixty-six 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. Twenty 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. Seventy-one 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.

Conclusion: 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. Although 20 patients (51%) in this group elected surgery and may be considered nonoperative treatment failures, those patients with successful nonoperative treatment had significant improvements in pain, function, and quality of life. Return to sports was comparable with patients with successful surgical treatment, although return to overhead sports at the same level was difficult to achieve (66%). Based on these findings, a trial of nonoperative treatment may be considered in patients with the diagnosis of isolated superior labral tear. In overhead athletes and in those patients where pain relief and functional improvement is not achieved, surgical treatment should be considered.