Wk 4, Case 4 - Review

Patient History
68 year-old male with decreased left shoulder range of motion and pain after a swimming injury.

Findings
ROTATOR CUFF: High-grade partial-thickness articular sided supraspinatus avulsion/tear (PASTA), dissecting medially into the myotendinous junction, measuring 1.9 cm medial to lateral x 1.4 cm anterior to posterior. Undersurface scuffing and partial-thickness microtearing of the infraspinatus, less than 10% of the tendon thickness, no full-thickness infraspinatus tear. Normal teres minor. Interstitial 2.2 cm long x 9 mm height subscapularis footprint tear. No retracted subscapularis tear.

SUBACROMIAL/SUBDELTOID BURSA: Mild subacromial/subdeltoid peritendinitis.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): No volume loss or fibrofatty infiltration of the rotator cuff musculature.

BICEPS TENDON: The biceps long head tendon is perched on the lesser tuberosity, but not dislocated or torn. Moderate complex extra-articular biceps tenosynovitis. Synovitic bodies in the biceps sheath.

AC JOINT: Moderate hypertrophic acromioclavicular arthropathy. Osseous spurring at the inferior aspect of the joint contributes to medial arch stenosis and impingement upon the traversing rotator cuff. No AC joint separation.

CORACOCLAVICULAR LIGAMENTS: Normal.

SUBACROMIAL ARCH/OUTLET: Laterally tilted type 2 acromion without lateral arch stenosis or outlet related cuff impingement.

SUBCORACOID ARCH: No subcoracoid stenosis.

GLENOHUMERAL JOINT: Mild glenohumeral joint space loss, bony spurring, capsulitis, synovial thickening. Superior glenoid erosions and marrow reaction.

GLENOID LABRUM: Posterosuperior SLAP 1 labral tear/fraying. Chronic posterior degenerative labral rim tear.

BONES: No macrofracture or avulsion fracture. Mild marrow reaction in the greater tuberosity of the humerus near the supraspinatus and infraspinatus insertions.

SUBCUTANEOUS SOFT TISSUES: No soft tissue swelling or mass.

AXILLA: No lymphadenopathy.

Impressions
High-grade partial-thickness articular sided supraspinatus tendon avulsion/tear, PASTA lesion, measuring 19 x 14 mm. No full-thickness tear, retraction, muscle atrophy or volume loss.
22 x 9 mm longitudinally oriented subscapularis undersurface and interstitial tear from the footprint, dissecting medially, without retraction. Moderate acromioclavicular arthropathy.
Mild glenohumeral arthropathy, SLAP 1 superior labral fraying, and complex capsulitis.
Perched long head biceps tendon, without dislocation, tendinosis, or tear, suggesting pulley mechanism weakness. Biceps sheath synovitis.