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Wk 5, Case 1, Shoulder MR - Review

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Report

Patient History

Patient referred for MRI subsequent to moderate dull right shoulder pain after surgery for tendon reattachment 3 months ago. Difficulty with all movement. Weakness.

Findings

ROTATOR CUFF: Moderate, saucerized, inflamed, confluent tendinosis of the rotator cable and conjoined tendon mostly involving the supraspinatus footprint fibers contiguous to a focal rim-rent tear at the humeral surface of the supraspinatus footprint.

Moderate tendinosis and interstitial delamination of the superior subscapularis.

SUBACROMIAL/SUBDELTOID BURSA: Moderate reactive peritendinobursitis, mostly anteriorly.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Preserved muscle girdle.

BICEPS TENDON: Intact.

AC JOINT: Mild AC joint arthropathy.

CORACOCLAVICULAR LIGAMENTS: Normal.

SUBACROMIAL ARCH/OUTLET: Narrowed due to a type 3/hooked acromion with downsloping and a thickened coracoacromial ligament.

SUBCORACOID ARCH: Mildly narrowed.

GLENOHUMERAL JOINT: Small effusion with reactive synovitis. No internal debris or free bodies. Normal glenohumeral ligaments. No arthropathy.

GLENOID LABRUM: Fraying of the superior labrum. No displaced labral tears or paralabral cysts.

BONES: Focal area of rim-rent penetration at the anterior humeral head facet with a subcentimeter subcortical arthropathic cyst.

No fracture or dislocations.

SUBCUTANEOUS SOFT TISSUES: Mild glenohumeral periarticular soft tissue swelling.

AXILLA: No space-occupying lesions. No fibroinflammatory changes.

Impressions

1. Focal rim-rent tear of the supraspinatus humeral surface anterior footprint fibers with cortical penetration and formation of a subcentimeter subcortical arthropathic cyst at the anterior humeral head facet.

2. Rim-rent tear is contiguous with a saucerized and inflamed interstitial delamination of the rotator cable and conjoined tendon mostly involving the supraspinatus fibers in keeping with a partial articular tear extending into the tendon substance (PAINT) lesion.

3. Moderate anterior subacromial/subdeltoid bursitis.

4. Narrowed lateral subacromial arch due to a thickened coracoacromial ligament and a type 3/hooked downsloped acromion.

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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