Patient History
52 yo M with right shoulder pain and slight limited ROM, ongoing for 3 months. No known injury.
Findings
ROTATOR CUFF: Concealed interstitial delamination of the rotator cable and conjoined tendon involving the humeral and articular surfaces.
High-grade, near full-thickness humeral side tear of the subscapularis tendon measuring 2-2.5cm in transverse length.
Derangement of the coracohumeral transverse ligament.
SUBACROMIAL/SUBDELTOID BURSA: Nominal diffuse peritendinobursitis.
Mildly thickened coracoacromial ligament.
Type 2/curved acromion without downsloping.
MUSCLES (ROTATOR CUFF/DELTOID, TRAPEZIUS, PECTORALIS): Normal muscle girdle.
BICEPS TENDON: Intraarticular dislocation of the long head of the biceps tendon. Saucerized hypertrophic tendinosis and interstitial delamination of the intraarticular or arcuate segment.
AC JOINT: Mild AC joint osteoarthrosis.
CORACOCLAVICULAR LIGAMENTS: Intact.
SUBACROMIAL ARCH/OUTLET: Slightly narrowed.
SUBCORACOID ARCH: Narrowed.
GLENOHUMERAL JOINT: No arthropathy. No signs of capsulitis.
GLENOID LABRUM: Chronic-appearing, saucerized nondisplaced bucket-handle tear of the superior labrum extending from anterior to posterior with extension to the biceps anchor. No paralabral cysts.
BONES: No acute fracture or evidence of glenohumeral dislocation. Mild posterior decentering of the humeral head.
SUBCUTANEOUS SOFT TISSUES: Unremarkable.
AXILLA: Unremarkable.
Impressions
1. Right shoulder biceps pulley mechanism injury with high-grade near full-thickness humeral side tear of the subscapularis tendon, full-thickness tears of the coracohumeral and transverse ligaments; intra-articular dislocation of the long head of the biceps tendon.
2. Chronic-appearing, saucerized, bucket-handle SLAP type 4 tear of the superior glenoid labrum that extends to the biceps anchor.
3. Mild confluent tendinosis of the rotator cable and conjoined tendon.
