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<v ->Dr P here, we're into

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the Motor S.E. classification system of SLAP lesions.

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We got VIII, IX and X, and we're on IX.

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22 year old young man doing a handstand

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who falls from the handstand position.

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Does not report a dislocation.

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Reports decreased range of motion.

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And he's got a SLAP IX.

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Now I'm going to pull down for a moment

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the sagittal projection

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because it shows a circumferential pattern of,

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at the very least, swelling and some focality too.

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Now in a SLAP IX, there is involvement of nearly

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the entire circumferential aspect of the labrum.

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So if we drew it, that's pretty easy.

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You just draw an ellipse around

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the pear-shape glenoid labrum, and you've got it.

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Except in reality, when you have a chronic SLAP IX,

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in my experience, the axilla is often spared.

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So it looks more like this

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and you can see the labrum is a bit pear-shaped.

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And people that have the other type of SLAP IX,

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which is traumatic SLAP IX dislocation

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plus pre-existing lesion, in my experience,

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then 360 degrees of the labrum are involved.

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So two types.

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Acute chronic, 360.

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Chronic, about 270 degrees.

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All right, so now let's call up our axial

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and we're going to start up high on our axial.

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And we immediately see

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that there's something there in the anterior labrum.

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There's something in the posterior labrum.

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Let's keep going down.

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That line in the anterior labrum is persistent

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and rather scissor-like and well-defined.

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There's certainly something still in the posterior labrum

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and it's getting more complex.

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Our line hasn't gone away

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and our line is actually getting bigger

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and wrapping around the bony glenoid.

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Our posterior labrum looks worse.

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Our anterior labrum looks worse

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and it just keeps on going.

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Maybe a little better right there

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but certainly worse back there.

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And as we get down low, the labrum is in a funny position.

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There is a scissor-like tear in the posterior aspect.

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And then in the axilla, there's also components of a tear.

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So now let's look in the coronal projection.

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Sometimes it's easier to see up very high

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and very low in the coronal projection, and we do.

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I've got the T1 up here as a reference,

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but all the T1 does is confirms the presence of

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a typical write-off apex Hill-Sachs fracture.

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Which tells you that this individual

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had a dislocation despite the history.

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So let's go up front for a minute.

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Let's go all the way up front.

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This is all abnormal.

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Let's keep going.

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Still abnormal.

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That's a normal recess

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between the biceps and the adjacent tissues.

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So let's go backwards.

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Still abnormal, still abnormal,

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still abnormal, abnormal.

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So high and low on the coronal, very easy.

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Still abnormal, still complex tear.

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Let's go all the way back.

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Abnormal, abnormal.

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It never gets normal again.

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And these two eventually meet right here.

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So they all come together.

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360 degrees of the labrum superior, inferior,

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anterior and posterior.

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Here we are back, anterior and superior again

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with a large complex tear.

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If I go back to the sagittal,

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you'll see the massive Hill-Sachs lesion right there.

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The so-called flat back syndrome that is associated

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with the Hill-Sachs impaction fracture.

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So this is a Motor S.E. SLAP IX, two types.

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270 degrees, chronic.

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360 degrees when you have a collision lesion

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with a dislocation superimposed

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on an already diseased labrum.

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Let's move on, shall we?