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This is a 60-year-old woman who had an injury to her

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left shoulder following a motor vehicle accident.

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And the main finding here involves

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the long head of biceps tendon.

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So the tendon is markedly thickened, and if we look at

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the composition of the tendon, we can see individual

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longitudinal split tears within the substance of the tendon.

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So this is the classical pattern of biceps

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tendon tear with longitudinal splitting.

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That typically starts from the intraarticular portion.

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So what I'm going to do now is to track myself into

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the joint space and look for that same pattern.

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There it is.

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We have the superior glenoid right here.

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And the takeoff of the long-headed biceps tendon, and if

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you look at the substance of the biceps tendon, we can

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see these high signal intensity linear areas within the

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biceps tendon compatible with a longitudinal split here.

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So, Severe tendinosis, marked thickening of the tendon with

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increased girth, and then longitudinal splintering that involves

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both the intra-articular and the extra-articular fibers.

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When we look at the position of the tendon itself, we can see

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that it's perching over the medial aspect of the biceps groove.

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So I'm going to draw here the biceps groove.

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And this medial aspect is the lesser tuberosity.

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We can see how the tendon is kind of perching over that

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medial edge of the biceps groove because there is an

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associated tear to the cranial fibers of the subscap tendon.

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So subscapularis tendon has a tear in the periosteum.

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most cranial fibers that is allowing the

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biceps to slide over the lesser tuberosity.

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And we have some reactive marrow edema

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in that location associated with it.

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Let's see what happens in the coronal plane.

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So we want to confirm the extension of the

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tear taking off from the superior glenoid.

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Here we have the supraglenoid tubercle.

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The supraglenoid tubercle, the biceps tendon taking off,

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and then we see those areas of high signal intensity, bright

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signal intensity, compatible with longitudinal split tearing.

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When looking at the extratricular portion

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between, located between the lesser and greater

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tuberosities, we see the very marked extension or.

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increased growth of the tendon itself, and

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then the longitudinal pattern of tearing.

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So this is very classic for severe tendinosis

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with partial thickness state of the biceps

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involving both the intra and extratricular portions.

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In this patient who had history of trauma, it's

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important, again, whenever looking at the long head

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of biceps tendon, to assess the superior labrum.

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So we see a focal detachment at the root of the superior labrum,

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at the base of the superior labrum, and this is compatible with

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a type 2 tear in a 60-year-old person, it could be expected that

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we have some degree of degenerative change and fraying of the

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free margin, but given the history of trauma, recent trauma, this

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could be actually associated with, uh, traction-related injury.

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In the sagittal plane, The biceps tendon is going

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to be seen exiting through the rotator interval.

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So we have the landmarks here, would be the supraspinatus tendon.

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I'm going to draw the supraspinatus tendon.

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And then here we have the footprint of the psoas

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capillaries tendon, the long head of biceps

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tendon exiting through the rotator interval.

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And we can see how the longitudinal split ends.

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Here holds true also in the sagittal plane

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involving both the intra and extratricular fibers.