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<v ->Dr. P here with a SLAP 10

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motor resting classification system.

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And we've got a 25 year old baseball player

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and football player with diminished range of motion.

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This is an MRI arthrogram

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and this case illustrates why

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I don't like to have just an arthrogram

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because you've got fluid properly injected

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by the arthrographer,

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but you also have some cystic masses

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and you're trying to tease out what are the cystic masses

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and what is the orthographic injection?

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So this is all orthographic fluid.

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The cystic mass is under pressure.

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It's more like the bulb of a thermometer.

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When you follow it back, you can follow it back

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to the anterosuperior labrum right here.

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And then coming off right there

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is the superior glenohumeral ligament

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with a little nubbin of high signal intensity

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right at its base under cutting it,

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and that is an example of extension of the tear

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into the base of the superior glenohumeral ligament

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with our cyst, dissecting into the rotator interval.

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They might say, "well how do you know that's a cyst?"

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The shape.

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This is a very common mistake to lose the cyst

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in a sea of introduced orthographic contrast.

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So now let's look in the sagittal projection

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just let's get some anatomy down here for a minute.

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Here is your biceps.

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Let's follow the biceps back

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and we see that it sits on the superior tubercle

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of the glenoid a little bit behind it, a little bit on top.

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So posterior dominant 56% of all biceps takeoffs

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and here's the glenohumeral ligament is probably

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MGHL right there.

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And there's the, SGHL.

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The SGHL not looking so good.

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It's a little irregular

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afraid it looks a little bit like a spider

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or a tarantula.

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Should be a nice clean linear structure.

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And there's some undercutting of it right there at its base.

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So extension of your SLAP lesion

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that involved the superior labrum

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into the base of the SGHL with a cyst

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in the rotator interval,

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very typical of a slap 10.

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Some are prone to call this a SLAP 2A with a cyst

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and I don't mind if you do that.

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Here's the cyst coming straight at you.

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Unlike the floppy deformed contrast

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in the rest of the joint,

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this is a nice perfectly round structure

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sitting there all by itself.

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And you can follow it right back

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into its little nubbin of a tear at the base

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of the superior labrum

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and you follow it out

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and it's pressing on the base of the SGHL.

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Now here's a little trick.

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Here's the T1 weighted image, and this might help you.

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You see the contrast, which is gadolinium laden.

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So the contrast on T1 imaging is bright

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as you would expect, T1 relaxation shortening.

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But if this was contrast, why would this be dark?

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It's not taking in contrast because it's our cyst.

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So if you're unsure

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whether you're looking at contrast

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or an actual cyst,

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frequently these cysts don't communicate,

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then I'd recommend you have at least

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one T1 weighted gadolinium augmented image

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as part of your arthrogram to distinguish the two.

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So cyst dark on T1, right on T2,

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but gadolinium is going to be bright

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on proton density fat suppression

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and bright on T1 spin echo imaging.

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So this is an example of a superior anterior labral tear

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with the section into the base of the SGHL

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and involvement of the rotator interval with a cyst.

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One quick piece of anatomy

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before our Dr. P signs off right here,

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a beautiful look at the biceps pulley mechanism.

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There's the biceps.

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There's the clerical humor ligament

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filled with contrast

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and underneath we see one segment, a more lateral segment

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of the SGHL.

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CHL, SGHL biceps.

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Dr. P out.