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<v ->Dr. P here talking about the Higher Orders

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of Motor SE Classification, eight, nine, and 10.

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We've got a hybrid 10 here, kind of a weird tear.

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Let's look at the sagillant anatomy first.

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I think you all can see this giant cyst.

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So, I won't draw on the cyst, but the cyst has a tail.

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And, the tail then goes into the rest of the tear.

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And there's gonna be more to the tear in a minute.

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What's really important and I've emphasized before,

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is the presence or absence of laying bare

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the base of the biceps.

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So, you've gotta be able to find the biceps.

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So, here's the biceps.

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And I want you to follow that as we scroll.

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You already see that the tear is right at its space

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and clearly, is going to undercut and expose

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the base of the biceps.

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So, now, let's scroll.

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And look at how extensive this tear is.

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It goes all the way down to the posterosuperior quadrant.

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It comes on up, it comes forward.

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And, there's the rest of the tear.

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So, here to here, to here, to here.

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Now, let's try tracking the biceps.

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There's the biceps.

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There's the biceps.

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The typical takeoff of the biceps

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is along the superior tubercle of the glenoid

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and a little bit posterior to it.

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So, called posterior dominant, which is what we have here.

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And the entire base of the biceps has a tear

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immediately underneath it.

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So, it is exposed.

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Let's go to the coronal projection.

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In the coronal projection,

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we see the tear at the base of the rotator interval,

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where it meets the anterior labrum.

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So, it's a little hard to see

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where we are without the axial.

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And, we'll do that in a moment.

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As we come forward,

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we get into this giant cyst that fills out

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the entire rotator interval.

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So, generally, I talk about slap tens in the setting

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of an interval tear and an SGH tear, SGHL tear,

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either or, or both.

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In this case, it's mostly an interval tear,

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but we're posterior now.

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Let's go anterior.

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Now, let's go posterior.

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And that tear just keeps on going.

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It's still going.

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And finally, it stops in the posterosuperior quadrant,

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as we've already elucidated.

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Now, let's go to the axial projection.

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So, this would be posterior.

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Let's just get you oriented.

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Posterior.

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Anterior.

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Here's your tear going from posterior to anterior.

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Going right out into the rotator interval.

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And, there is a rotator interval tear that I'll show you

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in a minute.

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And culminating in this huge rotator interval cyst.

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Now, let's scroll a little bit.

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And you see that the rotator interval is torn right here.

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You're out of the labrum.

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And you're in the interval right here...

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And this is labrum.

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And then, we'll take you back to the rest of the labrum.

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This is labrum now, here...

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right there.

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So, we've got a tear that extends out

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into the rotator interval.

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Tears the base of the rotator interval;

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is pressing on the base of the SGHL which sits right there,

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forms a huge cyst in the rotator interval space.

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So, this is a form fruste of a slap 10.

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Now, some of you might refer to this as a giant slap to see,

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posterior to anterior,

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flap like or fisher like, or scissor like

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with extension as assist

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in the anterosuperior rotator interval.

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And I don't mind.

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As long as you come up with the right description,

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you don't have to name it exactly right.

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Just make sure the clinician knows where it is,

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what quadrant it's in.

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Has it exposed the base of the biceps?

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Is there an associated cyst?

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And what is the excursion or extent of the tear

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on the clock phase of the shoulder?

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Dr. P., out.