52-year-old patient presenting with shoulder pain, typically aggravated by abduction and overhead activity.
Ultrasound examination of the shoulder demonstrates a small partial thickness tear located within the mid-substance of the supraspinatus tendon.
The lesion is visualized as a focal hypoechoic defect within the tendon, with localized disruption of the normal fibrillar architecture. The tear does not extend to the bursal or articular surface, consistent with an intratendinous (intrasubstance) location.
No clear evidence of a full-thickness tear is identified based on the provided findings. Additional tendon characteristics (e.g., degree of tendinopathy, bursal involvement, or Doppler signal) are not specified.
1. Final diagnosis
Small partial-thickness intratendinous tear of the supraspinatus tendon at the mid-tendon level.
2. Differential diagnosis
Consider focal tendinopathy with intratendinous degeneration mimicking a tear, or a small articular- or bursal-sided partial tear not fully visualized. MRI may help in equivocal cases.
3. Teaching points
Intratendinous tears can be subtle and appear as focal hypoechoic defects without surface disruption. Careful scanning in multiple planes is essential to differentiate true tears from anisotropy or degenerative changes.
4. Injury/disease information
Partial-thickness supraspinatus tears are common and may occur within the tendon substance, on the articular side, or on the bursal side. Intratendinous tears are often associated with chronic degeneration and may precede progression to larger or full-thickness tears.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.
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