Wk 5, Case 2, Shoulder MR - Review

Patient History

67-year-old male with left shoulder pain.

Findings

ROTATOR CUFF: Mild confluent tendinopathy of the rotator cable and conjoined tendon of the supraspinatus and infraspinatus. No full-depth, full-length or full-thickness tears.

Mild tendinopathy and interstitial delamination of the superior subscapularis.

SUBACROMIAL/SUBDELTOID BURSA: No bursitis.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Rotator cuff muscle girdle and rest of musculature is preserved.

BICEPS TENDON: Mild tendinopathy of the distal arcuate/intra-articular segment of the long head of the biceps. Biceps anchor fraying without tearing.

AC JOINT: Mild AC joint osteoarthrosis.

CORACOCLAVICULAR LIGAMENTS: Intact conoid and trapezoid ligaments.

SUBACROMIAL ARCH/OUTLET: Normal. Negative for stenosis or indirect signs of impingement.

SUBCORACOID ARCH: Mildly narrowed due to a downsloped type 2/curved acromion. The coracoacromial ligament is slightly thickened.

GLENOHUMERAL JOINT: Severe osteoarthrosis with goat beard deformity of the humeral head.

Dysplastic and vertical oriented glenoid cup with slight anteversion. Osteophyte spurring of the anterior and posterior glenoid rims.

Generalized chondromalacia consisting of full-thickness chondral plate delamination and mild subchondral stress osteoedema in the glenoid cup and weightbearing surface of the humeral head. Tiny subchondral arthropathic cysts at the medial aspect of the humeral head.

Slight posterior passive translation and malalignment of the humeral head.

Moderate joint effusion with reactive synovitis and internally calcified debris/free bodies, more conspicuous at the axillary pouch and posterior recess. Mild fluid distension of the subcoracoid bursa.

GLENOID LABRUM: Near complete circumferential detachment of the entire labrum in keeping with a SLAP type 9 injury. No paralabral cysts.

SKELETON: No fracture or dislocations. No intramedullary lesions. Synovial pitting along the posterior facet of the humeral head underlying the infraspinatus footprint usually seen in the setting of internal impingement with abduction external rotation positioning.

SUBCUTANEOUS SOFT TISSUES: Mild diffuse periarticular soft tissue swelling.

AXILLA: Normal. No adenopathy.

Impressions

1. Severe left shoulder glenohumeral joint osteoarthrosis with goat-beard deformity of the humeral head, dysplastic appearance and slight retroverted glenoid cup. Mild posterior passive translation and malalignment of the humeral head in keeping with posterior glenohumeral instability.

2. Generalized chondromalacia with multifocal areas of penetrating chondral fissures/erosions and tiny subchondral arthropathic cysts with mild stress osteoedema more conspicuous at the weightbearing surface of the humeral head.

3. Near complete circumferential detachment of the glenoid labrum in keeping with a SLAP type 9 lesion. No paralabral cysts.

4. Moderate joint effusion with reactive synovitis and internally calcified debris/free bodies conspicuous at the axillary pouch and posterior recess, likely from endochondral calcification.

5. Focal confluent tendinosis of the distal arcuate/intra-articular segment of the long head of the biceps and biceps anchor fraying.

6. Slight narrowing of the lateral subacromial arch due to a downsloped type 2/curved acromion and a thickened coracoacromial ligament. No rotator cuff tendinopathy.

7. Posterior glenoid deficiency syndrome with retroversion and humeral head decentering posteriorly.