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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 19 The SLAP lesion is diffi cult to identify with physical examination and generally requires high-tech diagnostic evaluation for accurate identifi cation. However, certain clinical signs can indicate the likelihood of a labral injury. As noted above, an essential factor is a detailed history that suggests some high-force load in the shoulder. There may also be popping or clicking of the shoulder during various motions. Pain may accompany the clicking or popping but is not always present. The second main labral injury type is a Bankart lesion or Bankart tear. This injury is a tear to the anterior and inferior portion of the labrum near where it blends with the inferior glenohumeral ligament (Image 3). This portion of the joint capsule and labral complex can also be stressed in repetitive overhead motions, such as throwing or serving a tennis ball. The Bankart lesion is also relatively common, along with shoulder dislocations. Another common mechanism of labral injury is falling on an outstretched arm. A labral tear may occur from corresponding joint capsule damage, or the humeral head being thrust against the edge of the labrum. In some more traumatic cases, a chunk of bone gets pulled away when the inferior glenohumeral ligament and labrum pull away from the glenoid fossa. This injury is called a Bankart fracture and requires an arthroscopic surgical procedure to repair. If you are suspicious of a labral injury, the best protocol is to refer the client to an orthopedic physician so the injury may be diagnosed and the best possible treatment initiated (which may require surgery). Other complications can develop as a result of labral tears. First, because of the poor innervation and circulation to the tissue, the tear may be signifi cantly advanced before it causes enough pain to be recognized by the client. SLAP lesion of the labrum. Image courtesy of Complete Anatomy. Bankart lesion on the inferior glenohumeral region. Image courtesy of Complete Anatomy. 2 3 SLAP tear along superior labrum Glenoid labrum Inferior glenohumeral ligament