Wk 5, Case 1 - Review

Patient History
39-year-old baseball coach with deep right shoulder pain when throwing.

Findings
ROTATOR CUFF: Diffuse tendinopathy of the supraspinatus rotator cuff with small or diminutive concealed interstitial delamination microtears or CIDs. Infraspinatus swelling and superficial fraying. Subscapularis, biceps pulley anchor, and teres minor normal.

SUBACROMIAL/SUBDELTOID BURSA: Diffusely swollen with multifocal areas of fluid anteriorly and to a lesser extent posteriorly. Fluid in the subcoracoid bursa.

MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Muscular patient. Suspect training and weightlifting activities. No fatty infiltration.

BICEPS TENDON: Normal.

AC JOINT: Hypertrophic arthropathy with erosions and spurring consistent with a young to middle-aged patient engaged in athletic or weightlifting activities.

CORACOCLAVICULAR LIGAMENTS: Normal.

SUBACROMIAL ARCH/OUTLET: Abnormal with slight downsloping of the acromion but a markedly thickened coracoacromial ligament contributing to impingement syndrome.

SUBCORACOID ARCH: Normal.

GLENOHUMERAL JOINT: Normal conformity. No craniad or anteroposterior decentering. Sagging or plasticity of the inferoposterior band of the inferior glenohumeral ligament is consistent with adaptive change of a throwing athlete.

GLENOID LABRUM: Normal. No SLAP lesions.

BONES: Marrow edema consistent with repetitive impaction due to impingement syndrome. Favor mechanical impingement against a markedly thickened coracoacromial ligament.

SUBCUTANEOUS SOFT TISSUES: Noncontributory.

AXILLA: Noncontributory. No masses or adenopathy.

Impressions
Subacromial arch outlet-related impingement with tendinobursitis and markedly thickened coracoacromial ligament.