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This is a 25-year-old woman who has a history of trauma while

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reaching overhead, and she's having pain with overhead motion.

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So let's go over these images.

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In these cases, we want to assess the superior labrum.

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And we're going to start with the oblique coronal sequence.

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In this case, it's an oblique coronal

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fat-suppressed proton density.

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And what I do is I try to find the supraglenoid tubercle.

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So it's this projection of bone,

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right on top of the glenoid rim where the biceps takes off.

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And this is very important because the quality of the biceps is

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going to determine the classification of superior labral tears.

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So, in this case, we are seeing a fluid, linear collection that

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is traversing the superior labrum at its base and extending

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from the free margin into the base portion of the labrum.

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When we go anterior to the long head of biceps tendon,

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we can see that fluid collection, linear fluid collection

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interposed between the free margin and the base of the labrum.

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This has been called the audi cookie sign.

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The cream is the fluid bright signal intensity,

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and then the base and the free margin of the

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labrum would be the dark portion of the cookie.

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As we go posterior to the long head of biceps tendon,

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we see that this tear is extending posterior to it.

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So we have a SLAP type II that is extending through the base

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of the labrum, and the long head of biceps tendon is intact.

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There is no extension of the tear into the biceps.

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So that is a key element in the classification.

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It makes the difference between a type II and a type IV.

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Now let's check the axial images.

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So here we can better see the audi cookie sign.

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So we have the fluid collection right there,

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interposed between the free margin of the labrum

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and the base of the labrum in this location.

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We can also see the takeoff of the biceps.

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And this is why the pathophysiology of superior

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labral tears is usually related to traction

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by the long head of biceps at its origin.

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So we have that in this patient.

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So, let's check the sagittal images in this patient, and

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we can see right here the takeoff of the biceps tendon,

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and we can track the biceps tendon on consecutive images.

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We're going to do that right now, and we

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can see the biceps is completely normal.

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So, in summary, we have a superior labral tear extending

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anterior and posterior to the long head of biceps origin

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without extension into the biceps fibers themselves.

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SLAP type II.