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Wk 4, Case 2, Shoulder MR - Review

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Report

Patient History

57-year-old female-bike accident. Pain in the right deltoid with soreness while raising arm over head. No prior surgery.

Findings

ROTATOR CUFF: Severe confluent hypertrophic tendinopathy of the rotator cable and conjoined tendon.

A 5mm x 15mm (width and AP dimensions, respectively) humeral side concealed interstitial delamination mostly involving the posterior supraspinatus and entire infraspinatus footprints and <10% of their thickness.

SUBACROMIAL/SUBDELTOID BURSA: Nominal diffuse peritendinobursitis.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Interstitial delamination/tearing of the superior infraspinatus myotendinous junction with formation of a small sentinel cyst measuring up to 2.5cm in length.

Normal subscapularis and teres minor.

Preserved muscle girdle.

BICEPS TENDON: Biceps anchor fraying, otherwise normal.

AC JOINT: Moderate AC joint osteoarthrosis with chondromalacia.

CORACOCLAVICULAR LIGAMENTS: Normal.

SUBACROMIAL ARCH/OUTLET: Type 2/curved acromion with downsloping. Normal coracoacromial ligament.

SUBCORACOID ARCH: Normal.

GLENOHUMERAL JOINT: Nominal osteoarthrosis. No signs of capsulitis or chondromalacia. No joint effusion.

GLENOID LABRUM: Inflamed, nondisplaced posterosuperior labral tear in keeping with a SLAP type 2C lesion. No paralabral cysts.

BONES: Area of rim-rent penetration at the posterior humeral head facet with synovial pitting.

SUBCUTANEOUS SOFT TISSUES: Normal.

AXILLA: No space-occupying lesions.

Impressions
1. A 5mm x 15mm concealed interstitial delamination (CID) involving the posterior supraspinatus and entire infraspinatus footprint and <10% of their thickness.

2. Interstitial delamination of the infraspinatus myotendinous junction with formation of a 2.5cm long sentinel cyst.

3. Background of severe confluent hypertrophic tendinopathy of the rotator cable and conjoined tendon.

4. Narrowed lateral subacromial arch due to a type 2/curved downsloped acromion.

5. Nominal peritendinobursitis.

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

Tags

Shoulder

Musculoskeletal (MSK)

MRI

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