Wk 3, Case 1 - Review

Patient History
44 year-old male with left shoulder pain during exercise for 6 months

Findings
ROTATOR CUFF: Interstitial concealed footprint tear of the subscapularis insertion, middle third from cranial to caudal, 4 x 5mm and involving less than 25% of the tendon thickness.

Humeral-sided, concealed interstitial delamination tear (CID) of the supraspinatus, 4mm x 4mm, 25% of the tendon thickness or less, associated with underlying marrow reaction and humeral head edema.

SUBACROMIAL/SUBDELTOID BURSA: Mild subacromial-subdeltoid peritendinitis.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Normal without fibrofatty replacement or volume loss. No sign of entrapment neuropathy.

BICEPS TENDON: Normal in the bicipital groove without tendinosis, dislocation, or tear.

AC JOINT: Mild active acromioclavicular arthropathy including capsulitis and periarticular marrow reaction. No AC joint separation. No medial arch stenosis.

CORACOCLAVICULAR LIGAMENTS: Intact without tear. Normal coracoclavicular distance.

SUBACROMIAL ARCH/OUTLET: Lateral tilt of the type 2 acromion with undersurface coracoacromial ligament thickening and acromion hypertrophy that causes impingement upon the underlying supraspinatus and infraspinatus. Mild stenosis of the lateral arch beneath the acromion.

SUBCORACOID ARCH: No stenosis or narrowing.

GLENOHUMERAL JOINT: No paralabral cyst. No adhesive capsulitis. No spur or erosion.

GLENOID LABRUM: Mild superior labral fraying.

BONES: Mild reactive edema or sterile inflammatory stress reaction deep to the supraspinatus tear. Otherwise normal without fracture or destructive lesion.

SUBCUTANEOUS SOFT TISSUES: Normal.

AXILLA: No lymphadenopathy or swelling.

Impressions
Two noncommunicating, concealed, nonretracted rotator cuff tears:
1. 3 x 4mm insertional subscapularis footprint, 25% tendon thickness or less.
2. Concealed interstitial delamination tear of the supraspinatus, 4 x 4mm, 25% tendon thickness or less.