Risk factors for the development of Superior labrum anterior to posterior (SLAP) tears in physically demanding occupations: a systematic review and meta-analysis

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Background: Currently, available evidence indicates people in physically demanding occupations (e.g., military or sport) may be at a higher risk of injury to the labrum than other occupations, with mechanisms involving acute forceful trauma or sustained mechanical forces exerted across the shoulder or hip joint. Therefore, the aim of this systematic review was to identify and synthesise findings from studies which reported the incidence or prevalence of Superior Labrum Anterior to Posterior (SLAP) tears in physically demanding occupations, and the risk factors associated with their development.
Methods: This review was conducted according to the PRIMSA-P guidelines and registered on the Open Science Framework. PubMed, EBSCO, Scopus, Web of Science, CINAHL and ProQuest databases were systematically searched using the following key terms: ‘labral tear’, ‘work’ and ‘risk’. Key findings from the included studies were extracted, including risk factors, prevalence or incidence and risk ratios (e.g., relative risk, hazard ratios, and incidence rate ratios). Each study included in the review was critically appraised to assess its methodological quality, using the Critical Appraisal Skills Programme (CASP) toolkit for cohort studies, and the Joanna Briggs Institute (JBI) case series critical appraisal tool for a case series study. Meta-analysis was conducted using the Cochrane Collaborations software package, Review Manager (RevMan, version 5.3). A random effects model was selected due to the variability in participant demographics and other characteristics across the included studies. OR and 95% CI were calculated.
Results: Six articles met the eligibility criteria, and these included three studies on professional athlete populations, two on military populations, and one study reporting on SLAP tears arising from workplace accidents or as a condition arising from occupational tasks. The methodological quality scores of the included studies ranged from 50% to 92%, with an average score of 73%. SLAP tears comprised 3.1% of shoulder injuries recorded over a 15-year period in the NFL and reported incidence in military populations was 2.13 [95% CI 2.11 to 2.16] per 1,000 person-years. Identified risk factors include younger age, male sex, acute weight-bearing and overhead movements, gameplay (as opposed to training), Army or Marine Corps service and enlisted rank. Meta-analysed data comprised from the military and sporting population studies, indicated strong evidence (p < 0.001; OR 11.40 [95% CI 5.65 to 23.02]; I2 = 35%) for the role of direct contact or trauma in developing SLAP tears compared to indirect or non-contact tasks.
Discussion: The findings showed individuals of male sex and of younger age, are at increased risk of sustaining SLAP tears. The results of the meta-analysis provided strong evidence that direct contact or trauma to the glenohumeral joint resulting from collisions or force directed to the shoulder from an abducted arm position was more likely to be associated with shoulder labrum tears (primarily SLAP, although inclusive of Bankart and other labral tears) than other forms of indirect force applied to the shoulder or non-contact mechanisms.
Impact: Tackling, blocking, collisions, repeated overhead shoulder lifting, combat sports, and sporting tasks predispose physically demanding occupations to increases in SLAP injury risk.
Conflict of interest statement: This research was funded by the Department of Veterans’ Affairs
Original languageEnglish
Pages (from-to)S46
JournalJournal of Science and Medicine in Sport
Issue numberSupplement 2
Publication statusPublished - 15 Nov 2022
Event2022 SMA Conference - RACV Royal Pines Resort, Gold Coast, Australia
Duration: 16 Nov 202219 Dec 2022


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