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<v ->Dr P here talking SLAP 2.

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And I break down SLAP 2 lesions into A, anterior

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B, posterior and C anterior to posterior.

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So let's look at this anterior lesion.

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There's a little bit of trickery here because

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anterior lesions, when they're very far anterior

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what sits right in front of them, the rotator interval.

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So sometimes the anterior labral tear

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may propagate into the rotator interval

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and then you're kind of into a hybridized SLAP 2a

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versus a SLAP 10, which is the rotator and of illusion.

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And we probably have that here

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but I'm gonna use this as my example of SLAP 2a.

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So we troll around on our T1 on the left, T2 in the middle

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and teach you fat sets

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our proton density fat set on the right.

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And as you scroll, you all see this fluid-like signal.

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Now, assessment of fluid-like signal is

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a little bit tricky especially for novices

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and those that are introducing to MRI.

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And the first thing I do when I see a

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cystic-fluidish looking thing is I decide;

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is it under pressure?

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Or is it kind of floppy?

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In other words,

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is it distorting the tissues around it pushing them away?

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Which usually means it's round or oblong?

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Or is it squished itself by the tissues?

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If it's squished, it's probably fluid in a recess.

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If it's expanding,

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kind of like a ganglion pseudocyst would expand

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because these are histologically identical

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to ganglion pseudocyst even though

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they're not strictly speaking ganglia,

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then you have to assume you've got a labral tear

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in the neighborhood.

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So we're trolling around and scrolling around

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and there's our big pushy looking cystic mass.

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Here it is on T1.

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Here it is on T2.

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Here it is on proton density fat set,

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and it's got lots of mass effect.

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In fact it's very well defined

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and somewhat oblong and lobulated in shape.

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In no way should you assume that this is fluid in a recess

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based on its mass-like character

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and the margins of it and what it does

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to the surrounding tissues.

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So now let's follow it back and you might say,

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"okay well where's it coming from?

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And, you go right into the biceps anchor right here.

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There's the biceps anchor.

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And you're still trying to find it's locus of origin.

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And it's pretty hard to do in this projection.

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In fact, I don't necessarily see it.

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So that would lead us to another projection

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because perhaps it's a tear in the rotator interval

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and not in the labor.

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So I would go straight to the sagittal.

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And when I go straight to the sagittal,

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there's the mass again.

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So this would be anterior.

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This is posterior.

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This is superior.

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This is inferior.

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Just to get you oriented,

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the axis of the pear-shaped Glenoid cup is right here.

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So this one's a little odd

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cause it's kinda curved or tilted so to speak.

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There's the pear.

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And now I'm gonna take it away.

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I'm gonna race.

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So your access is this way and this way, quite tilted.

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So now let's erase everything and

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go back to our mass which is right here and track it.

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And you're tracking through the rotator interval here.

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You've got this little squiggle in the interval

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and then you're into the labor right there.

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Now I got to cover it up.

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Now I'm gonna take it away and you're gonna see it.

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Yup! There's the tear.

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Oh! that's subtle.

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But that's what a SLAP 2a looks like.

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Propagates into this large paralabral pseudocyst

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which is histologically identical to the common ganglion.

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The differences the common ganglion, there's no tear.

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It's diffusion-related or it's microscopic.

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You can't see it.

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Here you've actually got a macroscopic lesion

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contributing to this.

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And that's the only difference between this type

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of pseudocyst and a ganglion pseudocyst.

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For those of you that are curious,

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the axial projection did show the tear, all those subtle.

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There it is right there.

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And there is the base of the cyst right in front of you.

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You can do a little scrolling right there.

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There's a little bit more of a tear.

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There's a little bit more of the tear again.

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And then here's your cyst

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pushing its way into the rotator interval space.

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SLAP 2a.

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Not to be confused with its counterpart to be

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in the back.