0:00

This is a 51-year-old man who is

0:03

having pain for three weeks.

0:06

And we are going to take a trip through the

0:09

rotator cuff in the oblique coronal plane to

0:12

assess the articular surface in this patient.

0:15

So, we are starting from the back and we are

0:19

see the articular surface has a thin low

0:22

signal intensity line, extending from the

0:24

myotendinous junction, right here,

0:26

into the footprint attachment at the

0:29

greater tuberosity.

0:30

We all see the low signal intensity line.

0:33

As we keep going towards the anterior

0:36

aspect of the greater tuberosity,

0:39

I want you to pay attention to that medial

0:41

margin of the footprint.

0:43

Because in this case,

0:45

it's very important to determine that there

0:48

is actually integrity of the articular surface fibers.

0:52

Now, if we go on the bursal surface of the

0:56

tendon, and I'm gonna go back again,

0:58

we can see that from the beginning, we have

1:01

some foramen of the bursal surface that is

1:04

also fluid within the subacromial-subdeltoid bursa.

1:08

And that is actually very useful in

1:11

diagnosing this type of tears because the

1:13

fluid on the bursal side is going to track

1:16

within the tendon defect and outline

1:19

the tear to a great stent.

1:22

And that is what we have here,

1:24

fluid in the subacromial subdeltoid bursa.

1:26

This is the subdeltoid portion of the bursa,

1:29

and we see the fluid tracking inside the

1:32

supraspinatus tendon on the bursal side.

1:35

This is the footprint, and as we had determined,

1:38

the articular portion of the supraspinatus

1:41

tendon is intact.

1:43

So, this is a high-grade tear of the

1:46

supraspinatus tendon, propagating from the

1:49

bursal surface involving greater than 75%

1:52

of the tendon substance.

1:53

In these cases, it's important for the surgeon

1:56

to know the size of the tear.

1:58

So we measure it both in the oblique coronal

2:01

plane and also in the sagittal plane.

2:04

So, we have roughly 0.9 cm in width

2:08

and 1.1 cm in anteroposterior dimension.

2:12

In this patient,

2:13

we can see on the oblique coronal plane,

2:15

the extension from the anterior, leading edge

2:18

of the supraspinatus, going posteriorly for about 1.1 cm.

2:24

Next important point to putting your reports is the

2:30

presence of fat infiltration.

2:32

So, what is the tendon here doing to the

2:35

health of the supraspinatus muscle?

2:38

And we're going to check the myotendinous junction here.

2:41

And what we have are the streaks

2:44

of fat within the muscle.

2:46

The streaks of fat are less than the muscle

2:49

fibers, so this is just a tricky change,

2:53

marbling of the muscle fibers,

2:55

consistent with a grade 1 muscle atrophy.

2:59

Grade 1 in the Goutallier system of classification.

3:03

So to wrap up, high grade partial thickness

3:07

tear of the supraspinatus tendon,

3:09

extending from the anterior line edge,

3:12

measuring 1.1 by 1 cm,

3:15

with associated grade 1 fatty infiltration

3:19

of the supraspinatus muscle fibers.