0:01

<v ->Dr P here.

0:01

Sagittal view of the shoulder, talking SLAP lesions.

0:05

Let's start out by getting our bearings.

0:07

You're looking into the glenoid cup,

0:09

and I'm gonna put a little dot

0:11

on the bare area of the glenoid,

0:13

which is a normal area of thinning,

0:15

and this is gonna serve as our reference point

0:17

for our clock or our watch.

0:20

Up top, obvious, Captain Obvious,

0:22

we've got 12 o'clock,

0:24

and then I'm going to use the anterior mid,

0:27

as three o'clock, also Captain Obvious,

0:30

and then six o'clock on the bottom,

0:32

and then nine o'clock over here,

0:33

and then everything else is self-explanatory.

0:36

Now sometimes the cup is tilted.

0:38

So if the cup is tilted this way, which it often is,

0:42

then this is going to be your axis.

0:44

So this is gonna be your 12 o'clock, not this.

0:47

So you always wanna be along the long axis

0:50

of the glenoid when you are making your clock.

0:55

So let me erase my long axis for a minute here.

0:57

And let's go back now and talk

0:59

about the Snyder classification, I through IV,

1:03

for SLAP lesions and this is pretty easy.

1:05

I think I need to get rid of my 12 o'clock too.

1:08

So SLAP I, SLAP I is considered a wear and tear,

1:13

very shallow, very superficial pattern of fraying

1:17

along the undersurface of the labrum.

1:19

It can be somewhat focal at anterior

1:21

or it can be broad all the way across.

1:23

It typically doesn't have a depth of greater than 50%

1:27

and may occur between the labrum and the glenoid

1:29

or in the superior labrum itself.

1:33

It doesn't have a lot of extension

1:34

much beyond the superior aspect of the labrum.

1:38

And most of these patients are clinically asymptomatic.

1:41

In fact, this is considered often in an adult

1:44

a wear and tear phenomenon, as previously stated.

1:47

So what's the difference between that and a SLAP II?

1:50

A SLAP II is more like a scissor cut.

1:53

It's very discreet, it's very linear.

1:56

It's a bit deeper, greater than 50% depth into the labrum,

2:00

and it may even go all the way through the labrum,

2:02

so if you're looking at the labrum

2:03

in the coronal projection,

2:05

and this would be your glenoid cup right here,

2:07

the tear may go all the way through the labrum,

2:09

from bottom to top,

2:10

or from quadad to craniad, and then out the top

2:13

and even result in the propagation of assist

2:16

spilling over the spinoglenoid rim.

2:19

So if you take a SLAP I, you make it a little deeper.

2:22

You make it more well-defined, make it a bit more focal,

2:26

you've got yourself a SLAP II.

2:28

And when you look down at that SLAP II,

2:30

say from the top down,

2:32

it typically is more linear rather than a gap.

2:37

So if you start to see gapping or widening,

2:40

then you start to consider something called a SLAP III,

2:43

which is basically a bucket handle tear

2:45

of the superior labrum.

2:47

Now for these superior labral SLAP II tears,

2:51

they could occur only in the back,

2:53

and when they do this is known as a SLAP IIB.

2:58

They can occur only in the front.

2:59

This is known as a SLAP IIA.

3:01

And if they occur all the way from back to front,

3:03

this is known as a SLAP IIC.

3:06

Then you get the SLAP tear where you've got

3:09

a pretty thick tear and you have the yellow,

3:14

you've got the yellow labrum augmented a little bit,

3:17

and then you've got some labrum underneath,

3:19

because it's been separated by this huge gap-like tear,

3:24

so that would be your SLAP III.

3:26

And if you're looking down from the top,

3:28

you'll see a big hole in the middle

3:30

just like a bucket handle tear in the knee.

3:32

And then on either side, you'll see some labral tissue,

3:36

and this may create what's known as the Cheerio sign.

3:39

And even though it's not perfectly round,

3:41

I'd call it a stretched out Cheerio,

3:43

looking from the top down,

3:44

this would be an axial view if you will.

3:48

So that one's the toughest one to conceptualize,

3:51

but then if you get into something

3:53

that is SLAP II-ish or SLAP III-ish,

3:56

and now it decides that it wants

3:58

to have its way with the biceps.

4:01

In other words, it starts to dissect into the biceps,

4:04

more often longitudinally than horizontally.

4:07

Now you've got a SLAP IV.

4:10

And these fulfill the Snyder criteria

4:14

for SLAPs I through IV,

4:15

the most noted amongst the SLAP classification.

4:19

Let's move on, shall we.