CHAPTER 47 • SHOULDER SUPERIOR LABRUM BICEPS AND PEC TEARS 281Bjerneld H, Hovelius L, Thorling J: Acromio-clavicular separa-
tions treated conservatively: A 5-year follow-up study. Acta
Orthop Scand54:743–745, 1983.
Bostman O, Manninen M, Pihlajamaki H: Complications of plate
fixation in fresh displaced midclavicular fractures. J Trauma
43:778–783, 1997.
Eskola A, Vainionpaa S, Myllynen P, et al: Outcome of clavicular
fracture in 89 patients. Arch Orthop Trauma Surg
105:337–338, 1986.
Eskola A, Vainionpaa S, Patiala H, et al: Outcome of operative
treatment in fresh lateral clavicle fracture. Ann Chir Gynaecol
76:167–168, 1987.
Eskola A, Vainionpaa O, Korkala S, et al: Four year outcome of
operative treatment of acute acromioclavicular dislocation.
J Orthop Trauma5:9–13, 1991.
Fukuda K, Craig EV, An KN, et al: Biomechanical study of the
ligamentous system of the acromioclavicular joint. J Bone
Joint Surg 68A:434–440, 1986.
Galpin RD, Hawkins RJ, Grainger RW: A comparative analysis
of operative vs. nonoperative treatment of grade III acromio-
clavicular separations. Clin Orthop193:150–155, 1985.
Harris RI, Wallace AL, Harper GD, et al: Structural properties of
the intact and the reconstructed coracoclavicular ligament
complex. Am J Sports Med28:103–108, 2000.
Jupiter JB: American Shoulder and Elbow Surgeons,1st Open
Meeting, Miami, FL 2000.
Kona J, Bosse NJ, Staeheli JW, et al: Type II distal clavicle frac-
tures: A retrospective review of surgical treatment. J Orthop
Trauma 4:115–120, 1990.
Lyons FA, Rockwood CA, Jr: Migration of pins used in opera-
tions on the shoulder. J Bone Joint Surg72A:1262–1267,
1990.
Martell JR: Clavicular nonunion: Complication with the use of
Mersilene tape. Am J Sports Med 20:360–362, 1992.
Mazet R: Migration of a Kirschner wire from the shoulder region
into the lung: Report of two cases. J Bone Joint Surg 25:477–
483, 1943.
Neer CS, II: Nonunion of the clavicle. JAMA172:1006–1011,
1960.
Nordqvist A, Petersson C, Redlund-Johnell I: The natural course
of lateral clavicle fracture. Acta Orthop Scand 64:87–91, 1993.
Nowak J: Clavicular Fractures: Epidemiology, Union, Malunion,
Nonunion. Uppsala, Sweden, Acta Universitatis Upsalaiensis,
2002.
Poigenfurst J, Rappold G, Fischer W: Plating of fresh clavicular
fractures: Results of 122 operations. Injury23:237–241, 1992.
Rockwood CA, Young DC: Disorders of the acromioclavicular
joint, in Rockwood CA, Jr, Matsen FAA, III: The Shoulder.
Philadelphia, PA, Saunders, 1990, pp 413–476.
Rowe CR: An atlas of anatomy and treatment of mid-clavicular
fractures. Clin Orthop 58:29–42, 1968.
Stanley D, Trowbridge EA, Norris SH: The mechanism of clav-
icular fracture. J Bone Joint Surg 70B:461–464, 1988.
Taft TN, Wilson FC, Oglesby JW: Dislocation of the acromio-
clavicular joint: An end-result study. J Bone Joint Surg
69A:1045–1051, 1987.
Weaver JK, Dunn HK: Treatment of acromioclavicular injuries,
especially acromioclavicular separation. J Bone Joint Surg
54A:1187–1198, 1972.
BIBLIOGRAPHY
Abbot AE, Hannafin JA: Stress fracture of the clavicle in a female
lightweight rower. A case report and review of the literature.
Am J Sports Med29:370–372, 2001.
Allman FL: Fractures and ligamentous injuries of the clavicle and
its articulation. J Bone Joint Surg 49A:774–784, 1967.
Egol KA, Connor PM, Karunakar MA, et al, F: The floating
shoulder: Clinical and functional results. J Bone Joint Surg Am
83-A:1188–1194, 2001.
Fallon KE, Fricker PA: Stress fracture of the clavicle in a young
female gymnast. Br J Sports Med35:448–449, 2001.
Hill JM, McGuire MH, Crosby LA: Closed treatment of dis-
placed middle-third fractures of the clavicle gives poor results.
J Bone Joint Surg Br79:537–539, 1997.
Rockwood CA: Fractures of the outer clavicle in children and
adults. J Bone Joint Surg 64B:642, 1982.
Tossy JD, Mead NC, Sigmond HM: Acromioclavicular separa-
tions: Useful and practical classification for treatment. Clin
Orthop28:111–119, 1963.
Tsou PN: Percutaneous cannulated screw coracoclavicular fixa-
tion for acute acromioclavicular dislocations. Clin Orthop
243:112–121, 1989.47 SHOULDER SUPERIOR LABRUM
BICEPS AND PEC TEARS
Jeffrey S Abrams, MDINTRODUCTION- Shoulder injuries that were felt to be rare and uncom-
mon are being diagnosed more frequently with clini-
cal examination, magnetic resonance imaging, and
arthroscopic surgery. - Increased participants in overhead athletics and weight
training have precipitated many of these injuries. - Eccentric muscle contraction can place excessive
loads on muscle tendon units, placing the superior
labrum, biceps, and pectoralis major structures at
risk.
SUPERIOR LABRUM- The superior labrum is the superior part of the carti-
laginous ring that surrounds the glenoid. The labrum
contributes to depth of the shallow glenoid, increasing
humeral head contact and stability.