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<v ->Dr.P here talking SLAP 1,

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a more superficial lesion.

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The Snyder classification criteria is what we are

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using right now and I am showing you

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three water weighted images

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with a lot going on in the shoulder.

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Let's ignore all the other busyness that's happening here,

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including the pathology and the rotator cuff

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and some AC joint disease

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and some swelling down here.

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Let's go right to the supere labrum.

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there are actually two major points I want to make here.

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One, there are a lot of fissures and sulci

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or sulcuses that sit along the antero superior anatomy.

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For instance, this curvilinear,

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but very well defined area,

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but pretty smooth and curved on the top

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represents the superior labral sulcus.

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Then you might say, well, okay a SLAP 1 lesion

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is a superficial less than 50 percent depth fissure,

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and that could be it, right? But that is not it.

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If you scroll a little bit, you'll see that,

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that is the thicker between the biceps take off

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and the superior labral. So that's a normal recess.

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Then you have another one right here.

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Now that one's a little easier,

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but that's the coracohumeral ligament interfacing

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with the biceps with a little bit of fluid interpose,

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so you have one, two, three potential marauders,

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or masqueraders as SLAP 1 lesions, none of which is it.

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So let's keep scrolling, because we are showing a SLAP 1

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and here it comes into view.

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A very irregular, frayed, ill-defined pattern

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of signal alteration right there,

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that involves the underbelly of the supere labrum.

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And then as we scroll a little bit more we see another one.

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Another area of fraying right there.

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Looks a little bit like a (indistinct).

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Not very deep, doesn't come out the top,

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no cysts, not that well defined.

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This is what you see in a wear and tear phenomenon

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of SLAP 1 and, supportive is the presence

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of wear and tear disease elsewhere.

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You got some arthritis in the AC joint.

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You got some rotator cuff pathology.

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You got some pseudo cysts in the humeral head,

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which suggests that there's a little bit of bobbing

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of the humeral head up and down,

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a little bit of micro instability,

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which probably wears on the supere labrum

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as it goes up and down and pushes up against it,

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further propagating and fulfilling

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our diagnosis of SLAP 1.