Evolving Concepts: Pathoanatomy and Pathomechanics of Labral Injuries in the Disabled Throwing Shoulder (DTS)—Moving Beyond the Slap

Labral pathoanatomy has been traditionally described in relation to the injury to the superior labrum (SLAP) and biceps attachment to the glenoid. This injury was believed to be the underlying pathology, and all the other tears seen were thought to be varieties of or extensions on the basic SLAP lesion. However, multiple areas of the glenoid labrum may be clinically relevant and suggest that study of the incidence and location of labral injuries for these injuries may help increase understanding of the pathoanatomy involved in the disabled throwing shoulder. These variations in pathoanatomic findings, in conjunction with the previously recorded relatively poor outcomes of treatment protocols based on the concept of the SLAP injury being the main pathoanatomy, moves the emphasis regarding the pathoanatomy to a more holistic view of the labral injury. The term “SLAP” may not be the most inclusive or effective term through which investigation of pathoanatomy, pathophysiology, pathomechanics, and treatment of injuries in the disabled throwing shoulder should proceed. This chapter reviews the anatomy, pathoanatomy, pathomechanics, and clinical evaluation process that create the diagnosis of a labral injury and suggests directions for operative and nonoperative treatment.