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<v ->Dr. P here with a 77-year old man complaining

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of shoulder pain and really no motion in the shoulder,

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which a SLAP lesion wouldn't typically do.

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They do get some motion, it's just they have pain

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with motion.

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And I think we have a good reason for his extreme pain

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with motion.

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It's right here. He's got hydroxyapatite deposition disease.

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But that being said, all this black stuff,

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let's move onto his labrum which is where we're focusing

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our efforts and today we're talking SLAP three.

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So cheerio my friends, we've got the Cheerio sign

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of a SLAP lesion.

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But before I introduce that sign to you,

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let's look at a knee meniscus. Yes, a knee meniscus.

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Even though we're in the shoulder.

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A little bit of ADD-ness perhaps. Going from one joint

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to another.

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Here is our meniscus and we get a little vertical tear

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of that meniscus and now what happens to the meniscus?

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The meniscus does this. It comes apart.

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Now you've got a big hole in the middle,

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for this thing widens or propagates this vertical tear.

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It gets wider and turns into a big blob

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that the meniscus itself starts migrating in

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to create this appearance.

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The so called bucket handle tear.

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Now let's take that away because the reason I show this,

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is that's what happens in the shoulder

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when you have a SLAP three.

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You get bucket handle tear with, when you look at the actual

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projection from the top down, the Cheerio sign.

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Except it's not really a Cheerio, because it's a little bit

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kind of long for a Cheerio.

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So maybe it's a stretched out Cheerio.

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Or a dysplastic Cheerio.

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Here is our Cheerio sign right there.

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There's our hole. There's a piece of labrum there.

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There's a piece of labrum there.

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Maybe I'll blow it up a little bit to give you better view

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of it. Oh, there it is.

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So here's a little bit of labrum here.

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Just to emphasis, a little bit of labrum right there.

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And a little bit of labrum around back

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and a little bit of labrum underneath.

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And in the middle is your hole for your Cheerio.

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Or your donut hole.

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Now let's keep going into another projection

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because I think the sagittal projection

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looks more bucket-like.

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I'm going to draw over it in a second,

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but there's the upper part of the labrum.

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Here's the saggy mesial and inferior part of the labrum.

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The labrum's coming apart. There's the hole in-between.

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So this looks a little bit more like a meniscus in a knee,

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right?

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I'm going to draw it for you.

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I'm going to pretend I've got a meniscus of a knee

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like this.

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Kind of like what a meniscus looks like.

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And now I'm going to draw it right here.

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Here's our meniscus of our shoulder,

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except now we've got this hole right here.

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And I'm not going to draw the hole,

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I'm going to draw the other part of the bucket right there.

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There's the other part of the bucket.

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And then I'm going to draw in the middle of the hole.

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So there's my bucket.

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So a bucket handle tear with a Cheerio sign

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is typical of a SLAP three.

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Now the coronal's a little bit tricky,

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because it looks like just a fat, linear tear.

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But actually what's happening is there is the labrum,

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there's the glenoid, there's a wide area of separation.

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And this area right here is just simply the front base

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of the biceps. That is not labral tissue.

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So, there's a huge cavern right here between the labrum,

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which is separated from the underlying glenoid,

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by this large gap, which is equivalent to this gap,

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which runs from front to back,

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which is equivalent to this gap,

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which runs from front to back.

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The Cheerio sign of SLAP three displayed

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in all three projections.

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Bucket-like in character.