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<v ->In the last minute, I'm just going to finish

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with a few comments about entheses and entheseal cysts.

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The definition of an entheses is a site

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of tendon or ligament attachment to bone.

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And I'd include attachment of joint capsule.

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Enthesitis or enthesopathy relates disease occurring

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at an entheses.

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Now, there are many entheses in the human body

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and the skeleton.

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We'll be seeing a few during these lectures.

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But one of the things we can see in some cases

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is where that tendon or ligament or joint capsule

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attaches to the bone.

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There is passage of fluid from that tissue into the bone.

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So I call these entheseal or subentheseal cysts, all right?

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Now, you know this because you have certainly seen these.

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And if I had to pick one area where perhaps

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you've seen them the most,

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it's in the greater tuberosity.

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So I want to say a word about

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these cystic changes that you see

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within the greater tuberosity.

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It's amazing to me that when we have sectioned

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the cadaveric shoulders through the years,

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how often we would see cysts in the greater tuberosity.

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And I'm showing you one example here.

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The attachment of the rotator cuff,

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particularly supraspinatus-infraspinatus

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tendons is a broad attachment.

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So this footprint of the entheses is very, very broad.

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When you talk about the supraspinatus,

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which we're seeing here,

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this is the end of the articular cartilage.

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There's no bare area

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of exposed bone between the articular cartilage

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and the footprint of the supraspinatus.

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If you go more posteriorly,

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and I'm not showing you that here,

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you would see that there is a bare area

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between the footprint of the infraspinatus

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and the articular cartilage.

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So if I showed you a section of that

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there would be exposed bone right here.

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So when you see subentheseal cysts

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in the greater tuberosity,

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they have less significance the more posterior they are

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because the fluid could get in through the bare area

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or bare spot between the footprint

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of the infraspinatus and the articular cartilage.

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But if you see those cysts at the attachment

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of the supraspinatus tendon,

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where there is no bare area,

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more likely than not, there is interstitial failure

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or delamination within that tendon, as shown here,

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allowing the fluid to extend in.

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Is it a clinically significant tear?

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That I don't know.

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Often the tear is very small

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and probably clinically insignificant.

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And with that, I'll stop

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and turn the program over to Rodrigo.