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<v ->This is a 52 year-old man.

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We're talking SLAP 4's right now.

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And this gentleman has some decreased range

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of motion and pain.

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Like every 52 year-old,

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he's got some AC joint disease.

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But we've got a better reason for his shoulder pain.

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When we get into the superior labrum,

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and here is the superior labrum on the sagittal.

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There is clearly a very broad, high signal intensity,

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pretty well-defined interstitial tear

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in the labrum.

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And there's the tear right there,

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scooching back a fair ways.

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And then as we follow it forward,

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it gets rather ill-defined.

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So let's try following it a little more anterior,

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and it gets bigger.

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And now you see it propagating

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into the leaves of the biceps tendrils.

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It's pretty bright and pretty wide.

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Let's look at the sagittal projection.

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Here's our SLAP lesion from the back to the front.

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Now let's scroll into the biceps.

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Wow, it goes right into the biceps,

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and makes it into a large white worm.

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And it keeps ongoing.

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This is the typical pattern

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that you're going to see in a SLAP 4.

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Now another very important analyzation criteria

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for you radiologists and imagers out there,

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is the clinician wants to know

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in every SLAP lesion,

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what is the relationship

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of the SLAP lesion to the biceps anchor,

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which means you have to identify the anchor.

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The best way to do that is to look at the anchor,

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be able to identify it, where it is,

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and where it sits on the glenoid.

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This one is pretty anterior.

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So here is the biceps right here.

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There's the labrum.

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So it's an anterior biceps takeoff.

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And it's not necessarily undermined by the tear.

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The tear's a little bit behind it,

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but the tear goes directly into it.

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So they want to know, is the biceps involved?

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Yes, is the answer here.

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Is the biceps undercut by the tear?

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The answer is no, in this particular case, SLAP 4.

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Let's move on, shall we?