0:01

<v ->Dr. P with a SLAP 2 and we're gonna focus on SLAP 2b,

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the one that's posterior.

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2a is anterior and 2c is anterior to posterior.

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Now this 70-some-odd-year-old man has had a serious injury.

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Our SLAP lesion is gonna be chronic.

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Down low, he has incurred an avulsion

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of the inferior glenohumeral ligament from the humeral neck,

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a so-called HAGL lesion,

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humeral avulsion of the glenohumeral ligament.

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With that HAGL, his capsular rupture,

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the fluid has leaked out into the soft tissues

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and often, the patients will have a subscapularis injury

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which this person has.

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Here's the subscapularis tear right there

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and the biceps is dislocating out of the bicipital groove.

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It's starting to lurch its way out and there is a tear

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of the coracohumeral ligament.

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Now let's return our thoughts to the superior labrum.

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Here's the superior glenohumeral ligament coming at you.

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There's the biceps and the coracohumeral ligament

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and these are areas of separation between those structures.

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They're normal with their normal course.

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They're delicate, not inflamed, no cysts.

1:14

Now let's scroll a little bit backwards

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and things are looking pretty peachy here.

1:19

And we start to see a little bit of chronic fissuring,

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not unexpected in a 70-some-odd-year-old gentleman.

1:26

Might have referred to that in isolation

1:28

as a degenerative SLAP in 1,

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not uncommonly seen in an elderly man.

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You see on the T2 weighted image,

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it hardly makes a signal at all.

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And as we keep going backwards,

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we expect to see those signals go away.

1:44

They should dissipate

1:45

and as we go posteriorly, they do.

1:47

But we see something else right here.

1:49

An extra triangle right there

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and there on the proton density fat saturation image

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and the T2 weighted image

1:57

and a separation between these two triangles right there.

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You even gotta blow it up a little more.

2:03

Now let's go a little more posteriorly and now,

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a cyst comes right outta there between the two.

2:08

And we see the cyst again.

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We're in the posterior superior quadrant, fragment, labrum,

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cyst, fragment, labrum, cyst on T2.

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And let's go to the axial projection.

2:20

Let's go up to that spot.

2:22

There is the cyst.

2:24

There should be a triangular black structure here.

2:27

There's the small wispy area of lower signal intensity.

2:32

There it is again now.

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A little more clear and darker

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but not in the right location.

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It should be over here.

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Lemme draw it for you.

2:39

It should be right there.

2:42

Now when I take my color away, you're gonna see

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just simply an adenitis structure there.

2:47

A fragment of swollen irregular labrum,

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another piece of labrum, irregular capsule

2:53

and then you've already seen the paralabral cyst.

2:56

Finding's consistent with a chronic SLAP 2b.