0:01

<v ->I want to talk about some weird idiosyncrasies

0:03

of SLAP lesions.

0:04

Dr. P here, and we've got our pear-shaped glenoid cup

0:08

in blue with a little bare area here in the center,

0:11

there's our bare area,

0:13

and here are some key structures anteriorly,

0:16

the superior and middle glenohumeral ligament,

0:18

the middle glenohumeral ligament being the most variable,

0:21

the superior glenohumeral ligament being the smallest,

0:23

and the largest and most consistent GHL is the IGHL

0:27

with its anterior band, axillary band, and posterior band.

0:32

Now first, the quadrant.

0:34

A SLAP lesion, SLAP stands for superior labrum,

0:37

anterior to posterior,

0:39

but sometimes, you get a lesion that starts here,

0:42

so not truly superior, more posterosuperior,

0:45

and it works its way around the back.

0:48

Now, it's not so important

0:49

that you know the designation right now,

0:51

which is a SLAP eight,

0:52

but just that it's not truly

0:55

a superior isolated superior labral phenomenon.

0:59

It's more of a posterior rim phenomenon,

1:02

yet this still gets the moniker SLAP eight.

1:05

So there's going to be a fair amount

1:06

of variability with regard to quadrant.

1:09

Second, you're going to have lesions

1:12

that collide with one another.

1:14

For instance,

1:15

you have a superior labral tear that's kind of chronic.

1:17

And then you dislocate and develop a big banker lesion here

1:21

maybe even with some bone involvement

1:23

and then this one propagates up this way

1:25

and this one propagates down that way,

1:26

and eventually they collide and meet each other

1:29

and that ends up being a SLAP five.

1:30

So collision lesions can occur

1:32

in conjunction with chronic SLAP lesions.

1:37

The next thing I want to cover is the biceps.

1:39

We talked about the importance of understanding

1:41

how a SLAP lesion relates to the base of the biceps anchor.

1:46

Clinicians want to know if it's in front,

1:47

underneath, or behind,

1:50

but one other highlight I want to make for you

1:52

is that the biceps has a highly variable origin.

1:56

So sometimes it comes off back here.

1:58

Sometimes the biceps comes off over here

2:00

and sometimes it even comes off in the front

2:02

conjoint with some of these other ligaments.

2:05

So that can be awfully weird

2:07

and a little bit difficult to analyze

2:09

if you're not used to this variability.

2:11

The next thing I want to mention are cysts.

2:14

Now the presence of a cyst slam dunk automatically

2:17

makes the diagnosis of a SLAP lesion.

2:19

You don't get ganglion pseudo-cysts

2:22

typically around the shoulder.

2:24

If you see a cyst, even if you don't see a SLAP lesion

2:27

the odds are it's a chronic SLAP lesion that is sealed over

2:30

and it's a ball valve phenomenon, it's simply scarred.

2:34

Now a lot of the cysts that you're going to see

2:37

are going to be posterosuperior,

2:40

they're going to spill over the spinal glenoid rim

2:41

into the suprascapular notch.

2:43

You're going to see them here.

2:44

But sometimes they'll behave rather weirdly.

2:47

So the ones in the front they can dissect

2:50

right around or under the SGHL.

2:52

I've seen them dissect into the SGHL.

2:56

I seen them dissect into the capsule and into the MGHL.

3:00

And then there's the very strange upside down lesion.

3:04

That's not from a dislocation.

3:06

It's the same as a SLAP two down here with paralabral cysts.

3:11

And although I made this up,

3:12

I call these the upside down SLAP lesion.

3:15

And if I have it without a cyst, I call it a SLAP 11.

3:18

If I have a with a cyst, I call it a SLAP 12,

3:20

even though it's down low.

3:22

So that's something I made up just to help you understand

3:24

and relate to this class of lesions

3:27

that are more often chronic than acute

3:29

although they can occur from acute trauma.

3:31

Let's move on. Shall we.