Patient History
Patient referred for MRI subsequent to moderate dull right shoulder pain after surgery for tendon reattachment 3 months ago. Difficulty with all movement. Weakness.
Findings
ROTATOR CUFF: Moderate, saucerized, inflamed, confluent tendinosis of the rotator cable and conjoined tendon mostly involving the supraspinatus footprint fibers contiguous to a focal rim-rent tear at the humeral surface of the supraspinatus footprint.
Moderate tendinosis and interstitial delamination of the superior subscapularis.
SUBACROMIAL/SUBDELTOID BURSA: Moderate reactive peritendinobursitis, mostly anteriorly.
MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Preserved muscle girdle.
BICEPS TENDON: Intact.
AC JOINT: Mild AC joint arthropathy.
CORACOCLAVICULAR LIGAMENTS: Normal.
SUBACROMIAL ARCH/OUTLET: Narrowed due to a type 3/hooked acromion with downsloping and a thickened coracoacromial ligament.
SUBCORACOID ARCH: Mildly narrowed.
GLENOHUMERAL JOINT: Small effusion with reactive synovitis. No internal debris or free bodies. Normal glenohumeral ligaments. No arthropathy.
GLENOID LABRUM: Fraying of the superior labrum. No displaced labral tears or paralabral cysts.
BONES: Focal area of rim-rent penetration at the anterior humeral head facet with a subcentimeter subcortical arthropathic cyst.
No fracture or dislocations.
SUBCUTANEOUS SOFT TISSUES: Mild glenohumeral periarticular soft tissue swelling.
AXILLA: No space-occupying lesions. No fibroinflammatory changes.
Impressions
1. Focal rim-rent tear of the supraspinatus humeral surface anterior footprint fibers with cortical penetration and formation of a subcentimeter subcortical arthropathic cyst at the anterior humeral head facet.
2. Rim-rent tear is contiguous with a saucerized and inflamed interstitial delamination of the rotator cable and conjoined tendon mostly involving the supraspinatus fibers in keeping with a partial articular tear extending into the tendon substance (PAINT) lesion.
3. Moderate anterior subacromial/subdeltoid bursitis.
4. Narrowed lateral subacromial arch due to a thickened coracoacromial ligament and a type 3/hooked downsloped acromion.
