68-year-old patient presenting with shoulder pain and functional limitation, likely aggravated by elevation and overhead activity.
Ultrasound examination of the shoulder demonstrates a suspected full-thickness tear of the supraspinatus tendon involving most of the tendon width (near-complete partial-width rupture). The tendon continuity is severely compromised.
There is moderate distension of the subacromial-subdeltoid (SASD) bursa, consistent with bursitis.
Increased synovial fluid is present within the glenohumeral joint, with visible distension of the posterior recess and extension into the biceps tendon sheath, indicating intra-articular irritation.
Additionally, there is capsular thickening and swelling of the acromioclavicular (AC) joint, consistent with synovitis.
1. Final diagnosis
Near-complete full-thickness supraspinatus tear with associated SASD bursitis, glenohumeral joint effusion, and AC joint synovitis.
2. Differential diagnosis
Consider complete supraspinatus rupture if visualization is limited. Inflammatory arthropathy may be considered in the presence of multi-joint synovitis.
3. Teaching points
Fluid in the biceps tendon sheath often reflects intra-articular pathology. Large or near-complete supraspinatus tears frequently coexist with bursitis and joint effusion. Evaluation of adjacent joints such as the AC joint is important in comprehensive shoulder assessment.
4. Injury/disease information
Rotator cuff tears can lead to altered joint mechanics and secondary inflammation, including bursitis and synovitis. Advanced tears may significantly impair function and are often associated with intra-articular fluid accumulation and multi-structure involvement.
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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