Wk 4, Case 1, Shoulder MR - Review

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Report

Patient History

52-year-old male with right shoulder pain and slight limited range of motion, ongoing for 3 months. No known injury. No history of surgery.

Findings

ROTATOR CUFF: High-grade tendinosis and interstitial delamination along the myotendinous junction of the superior subscapularis. Derangement of the medial sheath complex involving the coracohumeral and transverse humeral ligaments.

Mild tendinosis of the rotator cable and conjoined tendon of the supraspinatus and infraspinatus with tiny focal areas of concealed interstitial delamination along the supraspinatus footprint involving less than 25% of its thickness.

SUBACROMIAL/SUBDELTOID BURSA: Nominal diffuse peritendinobursitis.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Preserved musculature. No fatty infiltration or volumetric atrophy.

BICEPS TENDON: Severe confluent hypertrophic tendinosis and interstitial delamination with saucerized appearance of the entire arcuate/intra-articular segment of the long head of the biceps and biceps anchor without detachment. The biceps is subluxed medially.

AC JOINT: Moderate osteoarthrosis with spurring and multifocal areas of penetrating chondral fissures with formation of tiny subchondral arthropathic cysts. Mild capsulitis and periarticular soft tissue swelling. No separation or diastasis.

CORACOCLAVICULAR LIGAMENTS: Normal conoid and trapezoid ligaments.

SUBACROMIAL ARCH/OUTLET: Type 2/curved acromion without downsloping. Normal coracoacromial ligament.

SUBCORACOID ARCH: Narrowed. Slightly dysplastic coracoid process.

GLENOHUMERAL JOINT: No arthropathy or signs of adhesive capsulitis. Scant joint fluid. Thickened middle glenohumeral ligament (MGHL) with slightly increased signal.

GLENOID LABRUM: Thin and delicate superior anteroposterior labral tear without displacement or paralabral cysts.

BONES: Normal configuration. Normal bone marrow signal without evidence of marrow replacing process, fracture, osteomyelitis or osteonecrosis.

SUBCUTANEOUS SOFT TISSUES: Normal.

AXILLA: No lymphadenopathy or space-occupying lesions.

Impressions

1. Biceps pulley mechanism insufficiency due to a narrow subcoracoid arch from a slightly dysplastic coracoid process.

2. High-grade tendinosis with interstitial delamination of the superior subscapularis myotendinous unit and derangement of the transverse humeral and coracohumeral ligaments (medial sheath complex).

3. Medially interstitial type dislocation and severely tendinotic, saucerized arcuate/intra-articular segment of the long head of the biceps with anchor fraying.

4. Nondisplaced thin and delicate anteroposterior labral tear with extension into the MGHL in keeping a biceps-labral complex tear (SLAP type 4 lesion).

5. Mild tendinosis with tiny subcentimeter concealed interstitial delamination at the humeral surface of the supraspinatus footprint involving less than 25% of its thickness.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

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Wk 4, Case 1, Shoulder MR - Review