Wk 2, Case 2 - Review

HIDE

Report

Patient History
60-year-old female with left shoulder pain for 2 months following motor vehicle accident.

Findings
ROTATOR CUFF: Generalized swelling consistent with tendinopathy and mild peritendinitis in the infraspinatus. Supraspinatus intact with mild peritendinitis. Teres minor normal. Rotator interval diffusely swollen. Mild swelling of the subscapularis insertion.

SUBACROMIAL/SUBDELTOID BURSA: Mild diffuse swelling and hyperintensity.

MUSCLES: Mild generalized muscular atrophy without fatty infiltration perhaps most conspicuous in the infraspinatus.

BICEPS TENDON: Disorganized appearance of the normal laminar longitudinal fibers of the biceps long head is consistent with a high-grade complex partial-thickness longitudinal tear that involves the extra-articular and intra-articular portion of the biceps including its arcuate and transitional segments. Tendon normalizes as it approaches the biceps labral-anchor complex. The anchor itself is intact.

ACROMIOCLAVICULAR JOINT: Hypertrophy and mild swelling commensurate with age.

CORACOCLAVICULAR LIGAMENTS: Normal conoid and trapezoid ligaments.

SUBACROMIAL ARCH/OUTLET: Stenosis likely producing impingement and peritendinobursitis is predominantly produced by thick, hypertrophied coracoacromial ligament.

SUBCORACOID ARCH: Normal.

GLENOHUMERAL JOINT: Normal conformity. No anteroposterior decentering. No craniocaudad decentering.

GLENOID LABRUM: Fissuring or fraying of the superior and posterosuperior labrum consistent with wear and tear-related SLAP 1.

SKELETON: Areas of pitting and or pseudocyst formation at the posterosuperior lateral humeral head compatible with outlet-related and biomechanical impingement syndrome likely internal type related to contact of the humerus with the acromion in abduction and external rotation.

SUBCUTANEOUS SOFT TISSUES: Normal.

AXILLA: Normal. No adenopathy. No masses. No signs of entrapment neuropathy.

Impressions
Hypertrophic intra-articular and extra-articular longitudinal high-grade partial-thickness tear of the biceps long head sparing the takeoff at the anchor at the superior tubercle of the glenoid.