0:00

Now let me finish up in the last, uh, couple of minutes

0:03

with just one

0:05

or two diagnostic problems that you may encounter.

0:09

The first, uh, uh, is when do you call it a SLAP lesion?

0:13

As I've already told you,

0:14

I rarely if ever called in a patient over the

0:17

age of 30 years.

0:19

I clearly describe degenerative labral tearing in

0:23

that population, but I do not label that as a SLAP lesion

0:28

'cause you will see this often

0:29

as in this particular example.

0:31

This is not an autogram, this is a fluid sensitive,

0:34

it's an old case fluid sensitive coronal MR image.

0:40

How do you differentiate a detached superior labrum?

0:43

A SLAP two in parentes from a sub sub-label recess?

0:48

Well, on the axial plane, typically as we've described,

0:51

the space with a recess is not very wide,

0:55

one or two millimeters.

0:56

It is smooth, it is the same width, anthro superiorly

1:01

as post superiorly.

1:03

And generally, although not invariably,

1:05

it does not go posterior to the biceps anchor as opposed

1:10

to a flap lesion with a detachment that you can see here

1:15

that is wider than two millimeters is not the same with

1:20

antho superiorly and postero.

1:22

Superiorly has a tented appearance as you can appreciate

1:26

and can go posterior to the B subtenant

1:31

in the coronal plane.

1:33

The classic sub-label recess is smooth, curved,

1:37

paralleling the articular cartilage heading toward the

1:40

patient's head.

1:43

The slap lesion tear in this case will show

1:48

an abnormality that is not smooth as wider

1:51

and extends often toward the humeral head.

1:55

So that will help you differentiate the tooth.

1:59

How do you differentiate a slap lesion

2:02

that involves both the, the superior

2:04

and anterior labrum from a sub-label?

2:07

Foramen? Classically

2:08

but not invariably, the sub-label foramen ends

2:13

by a labral slip that will be continuous

2:17

with the labrum at the glenoid margin, no lower than three,

2:21

maybe three 30 or so.

2:23

Whereas if you have involvement superiorly

2:25

and antho superiorly, that labral detachment

2:28

or tear can extend lower down on the anter glenoid margin.

2:35

How do you differentiate a slap lesion also involving the

2:39

middle venum mal ligament from a developmental duplication?

2:45

If you know the answer, my email is dresnick@ucsd.edu

2:50

'cause I do not know the answer to this.

2:52

And indeed this was said

2:54

to be a developmental duplication at surgery.

2:59

And does differentiation of a prominent sub labral recess

3:04

does that in fact, is it important

3:08

to separate from a slap lesion?

3:12

And I wonder about that

3:13

because you see, I've seen by sectioning cadavers

3:17

smooth recesses that go far back superiorly.

3:21

And I believe that if they go that far back, you're dealing

3:24

with a mobile labrum.

3:26

This one goes back

3:27

and it looks like posterior to the biceps anchor

3:30

and perhaps the mobile labrum, it can be just as symptomatic

3:35

as a slap lesion.

3:37

And then finally, and developmental variations

3:40

and slap lesions occur together.

3:42

The answer is yes, particularly with a Buford complex

3:47

or a sub-label, foramen

3:50

with a cord like middle mal ligament.

3:53

Because indeed, in some reports, 80% of persons

3:57

with a Buford have had flap lesions, typically

4:01

with involvement, separation,

4:03

or tearing of the post rose superior all labrum.

4:06

So what I've done in my allotted period of time is to

4:11

describe both normal variations

4:14

and slap lesions involving the superior, uh,

4:19

portion of the glenoid or superior quadrant of the glenoid.

4:23

Hopefully I've given you some clues how to, uh,

4:28

separate the, uh, the two.