53-year-old male motor vehicle accident six weeks ago now experiencing pain and spasms

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Case History

Shoulder pain and spasms post MVC. Shoulder locked up reaching behind. Shoulder pops in and out four times in the last week.

Technical Factors

Long- and short-axis fat- and water-weighted images were performed. 1.5T High Field Oval.

Case Findings

Hill-Sachs fracture with floating IGHL (i.e. AIGHL – anteroinferior glenohumeral ligament) tear from both humeral and also glenoid labroligamentous detachment and medialization.
Acromioclavicular capsular edema is demonstrated without definitive evidence of high grade traumatic AC joint separation. The glenohumeral articulation appears relatively well preserved. Fluid signal is identified in the distribution of the subacromion and subdeltoid bursa. Glenohumeral capsular edema is noted.
Biceps long head tendon tear with extension or retraction inferior to the bicipital groove is demonstrated.
Supraspinatus full thickness tear with retraction nearly to the level of the AC joint is demonstrated at least 4cm retraction. There is no evidence of muscle atrophy. Humeral head elevation is indicative of unopposed action of the deltoid muscle. Full thickness distal infraspinatus tendon tear is also depicted. Teres minor appears grossly intact. Ill-defined subscapularis tendon tear is demonstrated.

Case Conclusion

Massive rotator cuff tear characterized by full thickness supraspinatus and infraspinatus tendon tear with the supraspinatus tendon retraction near the level of the AC joint. No evidence of muscle atrophy. Biceps long head tendon tear with extension or retraction distal to the bicipital groove. Coexisting ill-defined subscapularis tendon tear.
Osteoedema involving the posterosuperior aspect of the humeral head favoring Hill-Sachs deformity related to anterior dislocation over impaction fracture.
Hill-Sachs fracture with floating IGHL (i.e. AIGHL – anteroinferior glenohumeral ligament) tear from both humeral and also glenoid labroligamentous detachment and medialization.
Acromioclavicular and glenohumeral capsulitis accompanied by subacromion and subdeltoid bursal fluid collection (bursitis).

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