Patient History
57-year-old female-bike accident. Pain in the right deltoid with soreness while raising arm over head. No prior surgery.
Findings
ROTATOR CUFF: Severe confluent hypertrophic tendinopathy of the rotator cable and conjoined tendon.
A 5mm x 15mm (width and AP dimensions, respectively) humeral side concealed interstitial delamination mostly involving the posterior supraspinatus and entire infraspinatus footprints and <10% of their thickness.
SUBACROMIAL/SUBDELTOID BURSA: Nominal diffuse peritendinobursitis.
MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Interstitial delamination/tearing of the superior infraspinatus myotendinous junction with formation of a small sentinel cyst measuring up to 2.5cm in length.
Normal subscapularis and teres minor.
Preserved muscle girdle.
BICEPS TENDON: Biceps anchor fraying, otherwise normal.
AC JOINT: Moderate AC joint osteoarthrosis with chondromalacia.
CORACOCLAVICULAR LIGAMENTS: Normal.
SUBACROMIAL ARCH/OUTLET: Type 2/curved acromion with downsloping. Normal coracoacromial ligament.
SUBCORACOID ARCH: Normal.
GLENOHUMERAL JOINT: Nominal osteoarthrosis. No signs of capsulitis or chondromalacia. No joint effusion.
GLENOID LABRUM: Inflamed, nondisplaced posterosuperior labral tear in keeping with a SLAP type 2C lesion. No paralabral cysts.
BONES: Area of rim-rent penetration at the posterior humeral head facet with synovial pitting.
SUBCUTANEOUS SOFT TISSUES: Normal.
AXILLA: No space-occupying lesions.
Impressions
1. A 5mm x 15mm concealed interstitial delamination (CID) involving the posterior supraspinatus and entire infraspinatus footprint and <10% of their thickness.
2. Interstitial delamination of the infraspinatus myotendinous junction with formation of a 2.5cm long sentinel cyst.
3. Background of severe confluent hypertrophic tendinopathy of the rotator cable and conjoined tendon.
4. Narrowed lateral subacromial arch due to a type 2/curved downsloped acromion.
5. Nominal peritendinobursitis.
