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Failure of the biceps superior labral complex: A cadaveric biomechanical investigation comparing the late cocking and early deceleration positions of throwing

  • John E. Kuhn
    Affiliations
    University of Michigan Shoulder Group, Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, Michigan (J.E.K., S.R.L., L.J.H.); Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan (R.B.B.); and McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania (L.J.S.), U.S.A.
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  • Stephen R. Lindholm
    Affiliations
    University of Michigan Shoulder Group, Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, Michigan (J.E.K., S.R.L., L.J.H.); Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan (R.B.B.); and McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania (L.J.S.), U.S.A.
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  • Laura J. Huston
    Affiliations
    University of Michigan Shoulder Group, Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, Michigan (J.E.K., S.R.L., L.J.H.); Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan (R.B.B.); and McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania (L.J.S.), U.S.A.
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  • Louis J. Soslowsky
    Affiliations
    University of Michigan Shoulder Group, Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, Michigan (J.E.K., S.R.L., L.J.H.); Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan (R.B.B.); and McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania (L.J.S.), U.S.A.
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  • Ralph B. Blasier
    Affiliations
    University of Michigan Shoulder Group, Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, the University of Michigan, Ann Arbor, Michigan (J.E.K., S.R.L., L.J.H.); Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan (R.B.B.); and McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania (L.J.S.), U.S.A.
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      Abstract

      Purpose: The goal of the study was to determine which position of the throwing motion, late-cocking or early deceleration, was more likely to produce lesions of the biceps superior labral complex. Type of Study: Cadaveric biomechanical model. Methods: Ten paired cadaver shoulders were prepared and mounted on a custom testing apparatus in 60° glenohumeral abduction with the humerus in the plane of the scapula. All specimens were loaded with 100 cycles of subfailure external rotation torque (7.9 N-m) with 22 N applied to the rotator cuff tendons and long head of the biceps tendon. One of each pair of specimens was randomly tested in a late cocking position for throwing (>125° external rotation, 60° glenohumeral abduction, in the plane of the scapula). The other was tested in a position of early deceleration (80° external rotation, 60° glenohumeral abduction, 16° horizontal adduction). The biceps was loaded to failure with the shoulder fixed in these positions. The specimens were then examined by 2 experienced shoulder surgeons, blinded to the test protocol, to assess for the presence of a type II SLAP lesion. Results: Failure of the biceps superior labral complex occurred at the superior glenoid in 9 of 10 specimens in the late cocking position and in 2 of 10 specimens in the early deceleration position (P =.055). Five specimens developed type II SLAP lesions, with more in the late cocking position (4 of 10) than in the early deceleration position (1 of 10; P =.12). Load to failure was significantly less for the late cocking position (289 ± 39 N) than for the early deceleration position (346 ± 40 N; P =.004). Conclusions: These results suggest that the late cocking position may contribute to biceps-superolabral complex injuries in the thrower's shoulder.
      Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 4 (April), 2003: pp 373–379

      Keywords

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