47-year-old patient presenting with right shoulder pain, possibly aggravated by lifting, overhead activity, or side-lying.
Ultrasound examination of the right shoulder was performed according to the ESSR shoulder protocol, including additional assessment of the rotator interval structures such as the superior glenohumeral ligament (SGHL) and coracohumeral ligament (CHL).
The supraspinatus tendon demonstrates a small partial-thickness tear located in the mid-tendon region (intrasubstance / midsubstance location).
There is associated moderate tendinopathy of the supraspinatus tendon in the dysrepair phase, characterized by tendon thickening, reduced fibrillar organization, and altered echotexture.
No additional abnormalities are identified. The remaining scanned shoulder structures demonstrate normal sonographic anatomy.
Given the relatively limited structural findings, clinical examination is recommended to determine whether the imaging abnormalities correlate with the patient’s symptoms.
1. Final diagnosis
Small partial mid-tendon supraspinatus tear with moderate supraspinatus tendinopathy in the dysrepair phase.
2. Differential diagnosis
Consider asymptomatic degenerative rotator cuff change or pain arising from functional, cervical, or scapulothoracic sources if clinical findings do not correlate.
3. Teaching points
Small partial-thickness supraspinatus tears are common and may be incidental. Correlation between imaging findings and symptom provocation is essential. Tendinopathy in the dysrepair phase reflects a potentially reversible stage of tendon pathology.
4. Injury/disease information
Supraspinatus tendinopathy develops through repetitive loading, age-related degeneration, or altered shoulder mechanics. Partial tears may remain stable or progress depending on load management, function, and tendon health. Clinical context is key in treatment decisions.
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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