Patient History
51-year-old female with pain for 6 years with crescendo symptoms since December 2012. No known injury. Difficulty raising arm above head.
Findings
ROTATOR CUFF: Coarse interstitial dystrophic calcification invaded within the full-thickness of the supraspinatus footprint measuring 2cm anteroposteriorly and 1.7cm in width.
Mild confluent hypertrophic tendinopathy of the rotator cable and conjoined tendon of the supraspinatus and infraspinatus with interstitial delamination.
Moderate interstitial inflammatory changes along the supraspinatus muscle belly.
Intact subscapularis and teres minor.
SUBACROMIAL/SUBDELTOID BURSA: Mild diffuse peritendinobursitis.
MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Preserved rotator cuff muscle girdle volume.
BICEPS TENDON: Normal.
AC JOINT: Normal.
CORACOCLAVICULAR LIGAMENTS: Normal.
SUBACROMIAL ARCH/OUTLET: Mild narrowing due to a type 2/curved acromion with lateral downsloping and a thickened coracoacromial ligament.
SUBCORACOID ARCH: Normal.
GLENOHUMERAL JOINT: No arthropathy or signs of adhesive capsulitis. Normal glenohumeral ligaments. No joint effusion.
GLENOID LABRUM: Normal. No displaced labral tears or paralabral cysts.
BONES: Subcentimeter cortical area of rim-rent penetration surrounded by mild osteoedema underlying the anterior humeral head facet at the level of the posterior supraspinatus footprint.
No intramedullary lesions. No fracture or dislocations.
SUBCUTANEOUS SOFT TISSUES: Normal.
AXILLA: Normal. No lymphadenopathy.
Impressions
1. Calcific tendinitis involving the entire thickness of the supraspinatus footprint measuring 2 cm x 1.7cm. Findings usually seen in the setting of hydroxyapatite deposition disease (HADD).
2. Background of mild confluent hypertrophic tendinopathy of the rotator cable and conjoined tendon of the supraspinatus and infraspinatus associated with interstitial delamination and inflammatory changes along the supraspinatus muscle belly.
3. Focal area of subcentimeter rim-rent penetration at the anterior humeral head facet underlying the supraspinatus footprint surrounded by mild osteoedema.
4. Narrowing of the lateral subacromial arch due to a thickened coracoacromial ligament and a downsloped acromion associated with mild diffuse peritendinobursitis.
