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<v ->Dr P here with a SLAP 2 lesion.

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This is a 35 year old male,

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did not have a lot of other pathology, a little bit

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of impingement out by the rotator cuff insertion

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but his chronic shoulder pain is manifest

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by his superior labral tear.

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Now, we're in the anterior quadrant of the shoulder,

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we know that because of the shape of the glenoid

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and the shape of the humerus, you see the bicipital groove

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so that has to be in the front

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and you see this vague ill-defined signal

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in the anterior labrum which, by the way, is very common.

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So what do you do with this?

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I mean, how do you assess it as pathologic,

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degenerative or variant?

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Well, we'll talk about some of the variations

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a little bit later, but one is the direction.

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You know, the variant, the sulcus variant

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is gonna go this way, superomedial,

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and this is more ill-defined,

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in fact it's kind of shapeless, it's hard to define.

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So that's one criteria.

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A second criteria you can use

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is as you go back, it should go away.

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So now we're forward, now we're gonna go back.

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It's not going away.

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That's back, it's not going away.

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In fact, it's getting bigger and more prominent

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and not in the typical direction of a sulcus.

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It's getting even more prominent,

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now we see a mass or a cyst, it's coming right out the top.

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There it comes right out the top into this pseudocyst.

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So, right there you know that that signal anterior

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is contiguous with something in the back,

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it's probably pathologic.

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Then we have something else that helps us a great deal.

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As we follow it, anterior, it has a cyst in the front.

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So, the cyst is like a tracker jacker.

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The cyst tells you where the underlying

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labral tears occult, or not, are.

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Now, when we go to the axial we see the full extent

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of the tear, you say to yourself,

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"Well could that be a sulcus?"

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Not really, it's kind of serrated.

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Gonna make it a little more contrasty.

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See how serrated it is

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with these little niblets on either side of it.

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Then it gets a little narrower,

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then it gets a little wider,

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then it sends an offshoot this way, it stays pretty wide,

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then it comes out the back, its got a cyst

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like a thermometer bulb coming off the front

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so that has to be a tear.

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And as we go all the way up

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we've got another big cyst in the back

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spilling over the spinal glenoid rim

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into the suprascapular notch,

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therefore it has to be all the way

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from anterior to posterior SLAP to C.