The treatment of lesions of the superior labrum has advanced considerably over the past two decades of shoulder arthroscopy, as has understanding of this complex structure. A rarely recognized source of shoulder pain in the latter part of the 20th century has now become one of the largest indications for shoulder surgery in board-certified candidates. Although less common than superior labrum anterior and posterior (SLAP) types I and II tears, type III (bucket handle tear of the superior labrum), type IV (extension of the tear into the biceps tendon), and type V (type II lesion with an associated Bankart lesion) SLAP lesions of the shoulder have been associated with higher-demand occupations and recurrent glenohumeral instability. This chapter outlines the clinical history, examination, and radiographic findings of patients presenting with types III, IV, and V SLAP lesions of the shoulder, as well as details the arthroscopic methods of current treatment.

Arthroscopic management of patients presenting with SLAP types III, IV, and V tears centers primarily on the treatment of the biceps tendon and debridement of the superior labrum in type III tears, treatment of the superior labrum and biceps tendon in type IV tears, and the combined treatment of the Bankart and type II SLAP lesion in type V tears. Treatment of type III tears consists primarily of debridement of the bucket handle tear of the superior labrum, with or without biceps tendon debridement or tenodesis of the long head of the biceps if the tear extends into the biceps tendon proper (a type IV tear). Patients with type V tears typically undergo arthroscopic pan-labral repair of the superior and anterior inferior labrum; however, in patients over the age of 35, there may be an indication for biceps tenodesis for treatment of the type II lesion.