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<v ->Dr. P here with a 77-year-old lady with shoulder pain,

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and she's got a good reason to have it.

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Look at her AC joint.

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It is just a nasty mountain of proliferative tissue,

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both bone, synovium, and granulation tissue.

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But that's not what we're here to talk about,

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and also pay no attention to her

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concealed interstitial delamination tear

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with rim-rent penetration.

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But let's look at her superior labrum.

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Now right away, we see a curvilinear sort of organized

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following the trajectory of the glenoid sulcus there,

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and that doesn't bother me.

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But the line next to it,

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an accessory line that doesn't belong there,

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that bothers me.

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Now, in a 77-year-old, no problem.

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I, you know, I wouldn't be too concerned about that,

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although I might mention it in the body,

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just to be complete.

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But as we keep scrolling, it gets a little more complex,

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and often degenerative tears are complex.

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Now we go over to the T2,

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because of the chronicity of this lesion,

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most chronic lesions are either ill-defined

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or don't show up very well on the T2 weighted image at all.

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So the T2 weighted image, mostly for cysts

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and for fresh, active lesions.

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Not so good for chronic lesions,

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so keep that in mind.

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So let's keep scrolling now.

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And we go from our linear lesion to our complex lesion.

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We keep going and we see this

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funny-looking oblique signal right there.

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That is

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a sulcus

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between the labrum and the biceps takeoff.

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There is the CHL,

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and there's a little sulcus between the CHL and the biceps.

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Let's keep going.

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And anterior, we're all the way anterior now.

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Let's go posterior.

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Keep going in that direction.

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And wow, our linear thing,

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which was a little bit more complex anterior,

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now it's linear, more posterior,

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very complex.

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It goes up, it goes across, and it comes down.

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There's no way that can be normal.

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You all know that when we go from anterior to posterior,

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any sulcus-like signal, any variant signal

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in the anterior quadrant of the shoulder should go away.

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And this is certainly not going away.

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In fact, it's getting more defined

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and more complex in character,

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it's all the way into the posterior labrum,

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and now it goes right out the top

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of the posterior superior labrum,

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even though it has not formed a cyst.

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So let's go from the back to the front.

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There it is.

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There it is.

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We're moving forward.

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There it is again, there's a little erosion in the glenoid.

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It's coming down through the bottom.

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There it is again,

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not to be confused with the normal sulcus next to it.

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There it is again,

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and that's probably the last vestige of it

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before we get into the rotator interval space

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in the SGHL, or superior glenohumeral ligament and biceps.

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So this is an example of a chronic degenerative SLAP 2C

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in a 77-year-old lady, with all kinds of other problems.

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And now, one of the difficult things for you is

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what's producing her pain?

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Is it the SLAP lesion,

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or is it the AC joint?

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And this is where the physical examination

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is gonna mean a lot,

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as well as her symptomatology.

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Let's move on, shall we?