0:01

Okay, we're gonna move on with the program

0:03

and change directions, uh, slightly remaining

0:06

with the shoulder, but I'm gonna spend about, uh,

0:10

45 minutes

0:12

or so talking about the superior part of the shoulder,

0:15

the superior labrum, the nearby structures, and,

0:19

and basically look at normal and some variant anatomy.

0:23

And then look at the findings with SLAPP lesions

0:27

and see if we can sort out how to tell the difference

0:30

between normal and uh, abnormal.

0:34

I have a single, uh, objective for this particular lecture

0:37

to describe the important anatomic variants

0:41

that are found in the superior aspect

0:43

of the Glen Humeral joint, comparing their Mr appearance to

0:47

that of slap lesions.

0:50

So let's start by looking at the, uh, glenoid from the point

0:53

of view of the humeral head.

0:56

We're looking medially

0:57

and I'm showing you a basic shape of the glenoid.

1:00

The best I could do in PowerPoint, pointing out anter

1:03

and posterior aspects.

1:05

If you talk to, uh, orthopedic surgeons about the shape,

1:09

they will tell you, in fact that it looks like a pair.

1:13

Uh, tomorrow we'll talk about the inverted pair,

1:16

but with this in mind, about 10 years ago I went

1:19

to the supermarket 'cause I wanted to find a pair

1:22

that looked like this and I found the pair section

1:25

and they had about a hundred pairs

1:27

and I started looking at them one by one.

1:30

Uh, the other shoppers were not particularly excited about

1:32

that, but I went through all of them

1:35

and actually found nothing that looked like the glenoid.

1:38

Now they didn't have English pairs,

1:40

which apparently would look more like the glenoid.

1:42

So I was leaving the store very, very discouraged.

1:45

And lo and behold, in the next area, I found the avocados.

1:50

And although this isn't a perfect avocado with regard

1:53

to the glenoid, many of them do look like the glenoid.

1:57

Since I started talking about the avocado shape, a lot of my

2:02

previous fellows and scholars have sent me other fruit

2:05

fruits like the Chio Moya,

2:06

that's even better than the avocado,

2:09

but it was too late to kind of upgrade the, these slides.

2:12

You're gonna see a few avocados

2:14

during this particular lecture, starting with this slide.

2:17

Now, although there's a little bit of disagreement as to the

2:21

out location of the hours on the clock, face known

2:24

as the glenoid, I'm showing you here the general accepted

2:29

clock face, at least in the United States.

2:32

You can see here that the superior aspect indeed would be,

2:37

uh, 12 o'clock.

2:38

The inferior aspect would be six o'clock anterior generally

2:41

is regarded as three o'clock and posterior is nine o'clock.

2:45

Uh, when I describe labral abnormalities,

2:48

I include quadrants in addition to the hours, just

2:51

to be certain they know what I am talking about.

2:54

But these are the hours.

2:55

And for this particular lecture, unlike the lecture

2:58

I'm gonna be giving tomorrow on macro instability,

3:02

we're dealing only with a segment, uh,

3:05

in large part a segment.

3:06

This segment extending from about 10 o'clock

3:09

or so to two 30.

3:10

Perhaps we'll get to three

3:12

or a little past, uh, three o'clock.

3:15

So this is the part of the clock base

3:17

that's gonna dominate in this particular lecture.

3:21

The superior aspect, the upper quadrant

3:23

of the glenohumeral joint.

3:26

Now, right away you see the bad news.

3:27

The bad news is the number of structures that can be found

3:31

between the hours of 10 and two 30 or three.

3:34

There are many of them, and there're more

3:36

that I haven't put on this list,

3:39

and there are variations in all of them.

3:41

So that's a lot of bad news, but there is some good news.

3:44

The good news is statistically this is a time zone

3:48

of many normal variations and few pathologic lesions.

3:53

So the general rule that I have, if I see something strange

3:57

between the hours of 10 and three, that's not my work time,

4:00

but the glenoid face

4:02

that if I see something strange in those hours,

4:05

my first thought is, could this be an anatomic variation

4:09

if I don't think so?

4:10

My second thought is, is it just degenerative?

4:14

And then again, took more significant pathologic lesions.