0:00

This is a 40-year-old man with left shoulder pain,

0:05

and what catches our eye immediately is that there is

0:10

fluid surrounding the biceps tendon

0:13

within the biceps tendon groove.

0:16

When we look at the tendon itself,

0:19

the tendon is nicely defined,

0:23

low signal intensity throughout,

0:26

and there is no change in its SS caliber along the intraarticular and

0:31

extra-articular portions.

0:33

The only abnormality is the presence of fluid in the biceps tendon

0:38

sheath. When we have this finding,

0:42

our eyes should go immediately to the shoulder joint space.

0:48

Why?

0:48

Because the biceps tendon sheath communicates with the joint

0:53

space. And if there is fluid within the joint space,

0:57

if there is a joint effusion,

0:59

it will trickle down into the biceps tendon sheath.

1:04

In order to make the diagnosis of bicipital synovitis,

1:09

we want to see disproportionate fluid within the tendon sheath

1:14

as compared to the joint space.

1:17

And that's exactly what we have in this patient.

1:20

If we take a look at the coronal images, you can see the fluid signal intensity,

1:25

the extending the tendon sheath, and very,

1:28

very tiny amount of fluid in the subscapularis. So this is a,

1:33

this proportionate amount of fluid within the biceps tendon sheath

1:38

as compared to the joint space.

1:41

And we can safely make the diagnosis of synovitis.

1:46

Synovitis can be seen in the setting of tendon pathology,

1:50

biceps tendinosis, biceps tendon tears. But I,

1:55

as I pointed out at the beginning, the tendon itself is completely normal.

2:00

So we can adjust left with the diagnosis of bicipital synovitis.

2:04

In some instances, patients who also have

2:10

adhesive capsulitis may have bicipital synovitis.

2:15

So it is important to bring our eyes to the area of the

2:20

rotator interval and try to find pathology in this patient,

2:24

the coracohumeral ligament,

2:27

as well as the superior glenohumeral ligament and completely normal.

2:31

And there is no, um,

2:34

evidence of associated adhesive capsulitis.