61-year-old patient presenting with acute shoulder pain and functional limitation, likely following a recent event. Symptoms may include weakness in abduction and overhead activities.
Ultrasound examination of the shoulder demonstrates a complete rupture of the supraspinatus tendon. The presence of fluid within the tendon defect suggests a relatively recent tear.
The subscapularis tendon shows a moderate partial-thickness tear at its insertion.
There is moderate distension of the subacromial-subdeltoid (SASD) bursa, consistent with bursitis.
Additionally, there are signs of glenohumeral capsular irritation, with increased fluid observed around the long head of the biceps tendon and within the posterior recess of the glenohumeral joint, indicating intra-articular involvement.
No further structural details are provided.
1. Final diagnosis
Acute complete supraspinatus tendon rupture with associated partial subscapularis tear, SASD bursitis, and glenohumeral joint effusion.
2. Differential diagnosis
Consider acute-on-chronic rotator cuff tear. MRI may be useful to assess the extent of retraction and muscle quality.
3. Teaching points
Fluid within a tendon defect is a useful indicator of a recent tear. Rotator cuff tears often involve multiple tendons and are commonly associated with bursitis and intra-articular effusion. Evaluation of the biceps sheath can provide indirect information about joint pathology.
4. Injury/disease information
Acute rotator cuff tears can lead to rapid functional decline and pain. Involvement of multiple tendons and associated joint inflammation may worsen symptoms. Early recognition is important, as some cases may benefit from timely surgical evaluation, depending on patient factors and functional demands.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at EchoConsult in Roermond, the Netherlands.
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