Wk 2, Case 4 - Review

Patient History
51-year-old woman with a 4-month history of right shoulder pain, radiating down her arm, associated with decreased range of motion. Question rotator cuff tendinopathy or tear.

Findings
ROTATOR CUFF:

Supraspinatus: Tendinosis with peritendinitis accompanied by tendon thickening, heterogeneous increased intratendinous signal, and peritendinous edema with scant fluid signal in the distribution of the subacromial bursa. No macro tear.

Infraspinatus: Low-grade tendinosis with peritendinitis, similar to supraspinatus. No macro tear.

Subscapularis: Intact and unremarkable.

Teres minor: Intact and unremarkable.

Biceps tendon and anchor: Intact. Normal anatomic position. Diffuse periligamentous edema through the intra-articular segment. Small to moderate-sized bicipital sheath effusion. No evidence for tenosynovitis.

ACROMIOCLAVICULAR JOINT: Moderate arthrosis accompanied by subcuticular arthropathic cystic change and low-grade distal clavicular periarticular edema/stress response. Moderate capsulosynovial thickening with nominal edema suggesting a low-grade capsulitis.

CORACOCLAVICULAR LIGAMENTS: Intact.

SUBACROMIAL ARCH/OUTLET: Lateral downsloping of a type 2 acromion, combined with a mildly thickened coracoacromial ligament, contribute to mild-to-moderate lateral outlet encroachment.

SUBACROMIAL/SUBDELTOID BURSA: Mildly to moderately thickened, particularly in the subacromial portion. No effusion.

GLENOHUMERAL JOINT: Florid fibro-inflammatory capsulosynovial thickening that is intermediate to high signal on T2 and intermediate signal on T1. Capsular thickening pronounced through the axillary recess/IGHL, rotator interval, and superior capsular labral complex. No joint effusion. No intra-articular loose bodies. No high-grade chondromalacia of the glenohumeral articular surfaces.

GLENOID LABRUM: No traumatic or displaced labral tear.

BONES: No focal osteoedema, micro- or macro-trabecular fracture. No aggressive osseous abnormality. The humeral head is centered within the glenoid.

MUSCLES: Intact. No volumetric muscle atrophy.

SOFT TISSUE: Unremarkable.

AXILLA: Unremarkable.

Impressions
Dominant finding: Florid fibro-inflammatory type glenohumeral capsulosynovial thickening, compatible with clinical adhesive capsulitis.
Mild-to-moderate lateral outlet stenosis due to downsloping type 2 acromion and slightly thickened coracoacromial ligament. Coexisting mild supraspinatus and infraspinatus tendinosis and peritendinobursitis. No rotator cuff tear.
Mild-to-moderate AC joint arthrosis.