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<v ->Dr. P here with the illusive SLAP 6,

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which is basically a flap tear.

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I'm gonna start out with this 55-year-old gentleman

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who came in, rule out superior labral tear.

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And I'm gonna draw for a minute,

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a couple of interesting findings.

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We've got an erosion down low, you can see,

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extensive erosion in the inferior quadrant.

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There's something going on in the posterior mid aspect

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of the glenoid, I'm going to ignore that for now,

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and I'm gonna start scrolling right away,

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and I'm gonna take you to the rotator cuff real quickly.

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There's a concealed interstitial delamination

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of the rotator cuff, that's not my area of interest either.

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So I'm gonna go to the posterior quadrant,

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look at where I am, here's my glenoid,

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see the pear-shaped glenoid,

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and this is the access of the glenoid right here.

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And I'm in the back,

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and in the back I really don't see much.

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And I'm gonna start to come forward now,

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and as I come forward,

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I see a little something along the undersurface

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of the superior labrum.

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So is that a sulcus, or is that a tear?

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And it gets bigger, and more penetrating,

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and the shape becomes a little kookier.

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Looks a little bit like a bunny,

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there are the two bunny's ears.

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Let's keep coming forward.

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Now it's getting a lot bigger and a lot brighter

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with a weird course, almost horizontal,

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or horizontal oblique.

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And it's still getting even bigger.

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Now, a simple SLAP lesion would have about the same

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thickness, a simple SLAP 2, would have the same thickness

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as you go from back to front. Because it's a fissure.

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And it's a consistent fissure all the way

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from front to back.

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So, I'm gonna draw it for you.

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So if I was dealing with a SLAP 2, I'd have my labrum here,

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and then I'd have something that looks like this,

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consistently, on every single cut,

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and it would have the same thickness.

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But if I have a flap tear, wherever the flap is drooping,

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if it's drooping in the front,

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the tear is gonna get bigger in the front.

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If the flap is drooping in the back,

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it's gonna get bigger in the back.

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Let me show you what I mean.

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So let me draw a pear-shaped glenoid,

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and then let me draw the labrum.

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So I've got the normal labrum here,

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and I've got a flap here, the flap's falling down,

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so in between, I would have something that is edematous,

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or bright, and as I moved forward with my slices,

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this thing would get wider and wider.

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On the other hand, if the flap was going the other way,

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let me erase it. Let's draw another pear-shaped glenoid.

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Bit thinner there, and let's draw some labrum again.

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And here's my flap, actually,

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my flap is drooping in the back.

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Here's my labrum here, so, the gap between the two

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would be wider as I go posterior.

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So this interval between the two

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is gonna be wider in the back.

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In a SLAP 2, it's gonna be the same thickness

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all the way from back to front,

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or front to back, just to reiterate.

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Now let's go to our real case.

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Let's look in the sagittal projection.

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And I'm gonna scroll a little bit for you.

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Keep your eye right on this spot.

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Do you all see how this is triangular?

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It's thinner in the back, and wider in the front.

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That's because this part of the labrum is drooping down,

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and this part is standing up.

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So we basically have the situation

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that I eluded to in the beginning.

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Let's draw it.

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Here is my labrum, here is my flap,

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and here is the intervening triangle,

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this white thing in between,

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let me put some white color on it.

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Gonna draw that in.

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So now if I do a series of coronals,

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what am I gonna see?

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I'm gonna see something that looks like this.

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It's gonna be labrum, nothing.

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Labrum, thin layer of white, labrum.

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Now the layer of white gets thicker and thicker and thicker.

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If the flap goes the other way, it's gonna be the opposite.

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It's gonna get thicker as you go to the back.

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So that's how you identify a SLAP 6.

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As you go in one direction or the other, the tear widens.

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So let's look again in the coronal.

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We're in the back, we see nothing,

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we see a little something, it's getting bigger,

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and deeper, and wider, changing shape and getting bigger

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and deeper and wider and more conspicuous,

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and now it's blowing up like a balloon.

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That, my friends, is a SLAP 6.