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<v ->Dr. P. here.

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Here's a 20-year-old with shoulder subluxation.

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A subluxation is a pretty broad word.

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Sometimes the shoulder will come out

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and slip right back in,

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and somebody will call that a subluxation,

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even though the shoulder has been all the way out.

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So one of your jobs is to assess

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what's the damage that has been caused

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by this so-called subluxation.

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So right away, we start out with a T2

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and an accompanying

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proton density fat suppression and a T1.

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And the first thing you should notice

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is there is a big divot.

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You could ski off that mogul right there,

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and it's on all three images and it looks like it's active.

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There's some edema around it.

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There's some high signal filling the hole.

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And in its given location,

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you would be very suspicious about either upward subluxation

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of the humeral head creating a SLAP lesion

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or a medialized or apically positioned Hill-Sachs lesion.

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So the next thing I might do is go to the sagittal

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and see if I've got a flat back.

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In other words, the back of the humerus is flat,

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and indeed I do.

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So that is not a typical appearance

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for the bony lesion of an isolated SLAP lesion.

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It is typical of a shoulder dislocation.

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So I'm gonna ignore my T2 for now and bring up my axial.

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So let's start out up high.

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And even though it's a bit subtle,

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there is a line here that looks a little different

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than the normal hyaline interposition that you see.

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And then right away, you're into this funny looking cyst.

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Now let's look coronally as well.

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So in the coronal projection

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I'm gonna work off the PD rather than the T1,

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do concentrate on the middle image,

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and I'm even gonna make it bigger.

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I'm gonna grandstand the image.

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And there is no question that that is the sulcal area,

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and that is more lateral in the labrum itself right there.

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And let's go to another cut.

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Signals like that should go away as you go posterior,

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it's persisting, now it's gone.

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Let's come back to it.

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There it is again.

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There it is again.

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There it is again.

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And then you can see a signal that is a little too robust

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coursing down the front of the labrum, plus you have a cyst.

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So you should immediately be suspicious of a SLAP lesion.

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Then you also have a kind of an unusual configuration here,

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in that you've got this very large cord-like structure

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coming off the anterosuperior labrum.

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So there is a variant tear in which there is

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a cord-like glenohumeral ligament complex

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that makes this huge triangle as we come down.

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So this is a variation that you're going to see,

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although that doesn't distract us

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from the findings in the case.

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So we've already said, okay,

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we have a Hill-Sachs type lesion and it's pretty big.

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We better go downtown to the lower quadrant

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and see what's going on,

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and nothing good is happening here.

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It looks like the glenoid is a little small, right?

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You get a feel, nice big triangle, robust in the back,

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not so much in the front.

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It looks a little shrunken.

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And then you've got this piece of labrum

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all the way down low,

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and it is not firmly attached to the underlying glenoid.

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There's a big hole going through it.

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And then it's even a little bit more medialized

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into the axilla.

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So you've got yourself a good old fashioned

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soft Bankart lesion.

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Now let's return to the coronal projection

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and more corroboration of a traumatic injury.

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I'm gonna blow up my T1.

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And I'm doing that to make sure

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that I don't have a bony Bankart.

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And I don't.

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So everything looked a little small down low

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because the labrum was torn and cracked.

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Right there, there's a crack and a piece,

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there's a crack and a piece.

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There's not a firm attachment right there.

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There's another little fissure right there.

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This is all abnormal.

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There's some periosteal stripping.

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So we've got ourselves a real,

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good old fashioned Bankart lesion.

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Now, what do we do with this?

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What do we call it?

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Well, since we've got a superior labral tear

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that is in continuity with our inferior labral tear,

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we would call it a SLAP V.

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Now this can occur one of two ways.

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It can occur as a single lesion

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going all the way from top to bottom

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or more likely from bottom to top,

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or it could occur from a collision lesion.

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We have a preexisting chronic lesion with a little cyst,

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'cause it takes time to make a little cyst,

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and then you have an anterior inferior Bankart lesion

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and the two meet.

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They collide, so called collision lesion.

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And that's what we have here in this entity SLAP V.

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Let's move on, shall we?