Patient History
65-year-old female with pain with overhead movement and weakness in the rotator cuff.
Findings
ROTATOR CUFF: Severe confluent hypertrophic tendinosis and interstitial delamination involving the rotator cable and conjoined tendon extending medially into the posterior supraspinatus myotendinous junction. No evidence of full depth, full length or full-thickness tears.
SUBACROMIAL/SUBDELTOID BURSA: Moderate subacromial/subdeltoid bursitis.
MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): The rotator cuff and shoulder muscle girdles are preserved.
BICEPS TENDON: Mild hypertrophic tendinosis of the arcuate or intra-articular segment of the long head of the biceps.
AC JOINT: Mild AC joint osteoarthrosis.
CORACOCLAVICULAR LIGAMENTS: Intact.
SUBACROMIAL ARCH/OUTLET: Type 3/hooked acromion without downsloping.
SUBCORACOID ARCH: Thickened coracoacromial ligament.
GLENOHUMERAL JOINT: Nominal osteoarthrosis. No chondromalacia. Small joint effusion. No internal debris or free bodies. Glenohumeral ligaments are intact.
GLENOID LABRUM: Superior labral fraying without displaced tears or paralabral cysts.
BONES: Synovial pitting at the middle humeral head facet. No fractures or dislocations. No cortical breakthrough or periosteal reactions.
SUBCUTANEOUS SOFT TISSUES: Supraglenoid notch, axillary pouch and quadrilateral space are unremarkable.
AXILLA: No space-occupying lesions.
Impressions
1. Severe confluent hypertrophic tendinosis an interstitial/undersurface delamination involving the rotator cable and conjoined tendon extending medially into the posterior supraspinatus myotendinous junction in keeping with a partial articular side tendinous avulsion (PASTA).
2. Narrowing of the lateral subacromial arch due to a hooked acromion and a thickened coracoacromial ligament.
3. Moderate subacromial/subdeltoid bursitis.
4. Mild hypertrophic tendinosis of the arcuate or intra-articular segment of the long head of the biceps. Superior labral fraying. Findings are in keeping with a SLAP type 1 injury.
