Wk 1, Case 4 - Review

Patient History
21-year-old man with left shoulder pain.

Findings
ROTATOR CUFF:
Supraspinatus: Intact.

Infraspinatus: Intact.

Subscapularis: Intact.

Teres minor: Intact.

Biceps tendon and anchor: Small fluid collection along the bicipital groove. Mild tenosynovial thickening proximally. No subluxation/medialization.

ACROMIOCLAVICULAR JOINT: Capsulosynovial thickening with diffuse high-signal edema. Mild surrounding soft tissue high-signal edema/inflammation. Low-grade distal clavicular periarticular osteoedema/stress reaction. Mild diastasis. Intact acromioclavicular ligaments and capsule. No periarticular erosive change or arthropathic cyst formation.

CORACOCLAVICULAR LIGAMENTS: Intact and unremarkable in appearance.

SUBACROMIAL ARCH/OUTLET: No convincing evidence of active lateral outlet impingement.

SUBACROMIAL/SUBDELTOID BURSA: Unremarkable.

GLENOHUMERAL JOINT: No glenoid dysplasia, retroversion, or humeral head decentering. No effusion, capsulosynovial thickening, or intra-articular loose body. No high-grade chondromalacia of the glenohumeral articular surfaces.

GLENOID LABRUM: No traumatic or displaced labral tear.

BONES: Distal clavicular periarticular low-grade osteoedema. No other abnormal marrow edema. No micro- or macro-trabecular fracture or contusion. No focal or aggressive osseous abnormality.

MUSCLES: Diffuse global muscular prominence/muscle hypertrophy. No muscle edema/strain, atrophy, or fatty infiltration.

SOFT TISSUE: Unremarkable.

AXILLA: Unremarkable.

Impressions
1. Acromioclavicular joint capsulosynovial thickening with active capsulitis and stress-related osteoedema of the distal clavicle. In the absence of trauma, favor chronic stress/overuse and microinstability syndrome in an athletic individual. Less likely low-grade acromioclavicular joint sprain (grade 1).
2. Low grade proximal biceps peritendinitis.