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It's a 43-year-old male who presents

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with typical CAM-type symptomatology,

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as well as a labral tear.

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And those symptoms include pain, especially

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with standing, also with movement, and clicking.

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The patient has a deep superior labral

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tear, which we can see here as an area of

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irregularity that balloons a little bit

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as we go deeper, which a sulcus would never do.

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A sulcus has a more shallow configuration.

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It looks somewhat like this.

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As opposed to this sort of knife,

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knife blade appearance with ballooning

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on the tip that we see in this case.

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So more irregular and more

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unpredictability in terms of the overall

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signal as it dives into the labrum.

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A sulcus is much more shallow.

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And sulci are not maximized in their

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depth in the upper portion of the labrum.

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They're maximized at the 7 or 8 o'clock

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position in the anteroinferior quadrant.

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So everything is wrong with

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this lesion for a sulcus.

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It is a labral tear.

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And we have other secondary signs.

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For instance, if we look at the axial

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projection, let me go back to my PACS system here and scroll it.

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If we look at the axial, although I'm

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not going to measure the alpha angle

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for you, there is a large bump cyst

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complex with asphericity of the hip.

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In other words, there's no tapering

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from the head to the neck, but

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rather it's fat and irregular.

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But there's a reason I'm showing you this,

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this rather obvious labral tear, and it is to

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show the correlate in the other projection.

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And typically, the axial projection has a high

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sensitivity and high specificity for labral

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tears, especially with a small field of view

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and thin sections, such as that seen here.

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This axial was obtained orthogonally,

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but let's correlate the labral tear here.

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With the axial, and see

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exactly how subtle it is.

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This is anterior, this is posterior.

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Here's the top of the head,

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this is the acetabulum.

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There, that tiny little thing

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in the back, is our labral tear.

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So it requires a lot of back and

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forth to confirm your labral tear.

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And sometimes, if you see it in one view,

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you may find it in an unexpected view.

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For instance, 20 percent of all labral tears

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only show up well in the sagittal projection.

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So let's look at our sagittal,

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and find this labral tear.

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And we see it's actually a little

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bit posterior and lateral, off to the

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side, where we are very peripheral.

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And there it is, this tiny little

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defect in a position that lies just

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behind the top of, or apex,

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or 12 o'clock position of the femoral head.

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So it's a little posterior.

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If we made this a clock, we'd say

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it's at the 1 o'clock position.

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I have a T1-weighted image that also shows the

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tear as more of a through-and-through defect.

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Filling, with contrast, is an

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area of high signal intensity.

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And I also have another axial.

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Let me see if I can pull it up

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pretty quickly right here.

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Here's an oblique axial.

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And now we're going right through the tear.

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There's the tear.

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There is our oblique.

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And there is our defect.

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Look at how small and subtle that defect is.

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But it's real.

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This is a labral tear, with

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an arthrogram, and a

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1.0T open magnet, with a bump cyst complex.

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With correlative signal intensity

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and defects in every projection.

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Sagittal, axial orthogonal,

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axial oblique, and coronal.

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Let's move on to the next case, shall we?