Symptomatic Superior Labral Anterior Posterior Lesion With Absence of the Long Head of the Biceps Tendon.

This article is the first report of a superior labral anterior posterior tear associated with absence of the long head of the biceps tendon. A 17-year-old right-hand-dominant high school football player consulted the physicians for an injury to his left shoulder. The physician had reconstructed his knee 8 months before this visit, and he was returning for routine knee follow-up when he complained of left shoulder pain. Case history revealed that he had suffered increasing pain in the left shoulder 2 weeks before his visit, while performing a bench press. He denied any specific traumatic event, and since that day, he had been unable to perform a bench press or overhead activities. He did describe a few episodes, associated with some mild shoulder discomfort, of falling onto his left hand or arm while playing football in the past, but he did not recall an injury or event that he could specifically relate to the development of shoulder pain. His pain was predominantly anterior and superior in the bicipital groove and was associated with mild anterior joint line tenderness. He scored a 5 out of 5 in strength on his rotator cuff and upper extremity muscles. He had no acromioclavicular symptoms, no provocative impingement signs or biceps tendon maneuvers, and no evidence of anterior, posterior, or multidirectional instability.