52-year-old patient presenting with anterior shoulder pain and possible instability symptoms. Complaints likely aggravated by overhead activity and rotational movements.
Ultrasound examination of the shoulder demonstrates findings suggestive of a lesion within the rotator interval, likely involving the coracohumeral ligament (CHL) and/or superior glenohumeral ligament (SGHL).
This appears to result in instability of the long head of the biceps tendon within the rotator interval. The instability is associated with a cortical irregularity at the humeral head, consistent with a “chondral print sign,” likely due to repetitive abnormal contact.
The long head of the biceps tendon shows moderate to severe tendinopathy. The degree of tendinopathy is moderate within the intertubercular groove but more pronounced within the rotator interval, likely secondary to mechanical instability.
There is a small amount of fluid within the biceps tendon sheath.
The supraspinatus tendon demonstrates a mild to moderate articular-sided partial-thickness tear at the level of the anatomical neck. The adjacent cortical surface appears irregular and correlates with the site of tendon pathology.
Additionally, there is mild to moderate tendinopathy of both the supraspinatus and subscapularis tendons.
The subacromial-subdeltoid (SASD) bursa appears mildly thickened, possibly reflecting resolving bursitis.
1. Final diagnosis
Suspected rotator interval tear (CHL/SGHL) with secondary instability of the long head of the biceps tendon, associated with moderate to severe biceps tendinopathy and chondral print sign. Concomitant mild to moderate articular-sided supraspinatus tear and rotator cuff tendinopathy.
2. Differential diagnosis
Consider isolated biceps tendinopathy without true instability, or partial pulley lesion without complete rotator interval rupture. MRI may help confirm ligamentous involvement.
3. Teaching points
The rotator interval plays a key role in stabilizing the long head of the biceps tendon. Instability in this region can lead to focal tendinopathy and secondary bony changes such as the chondral print sign. Articular-sided supraspinatus tears often coexist and should be actively assessed.
4. Injury/disease information
Rotator interval lesions involve disruption of stabilizing ligaments such as the CHL and SGHL, leading to altered biomechanics and biceps tendon instability. Chronic instability can result in tendon degeneration and secondary osseous changes. These conditions are often part of a broader spectrum of rotator cuff pathology.
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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