Patient presenting with right shoulder pain and functional limitation. History reveals prior traumatic events, including a direct shoulder/neck trauma in 2019 and a later acromioclavicular injury (Tossy-type mechanism) during martial arts activity. Earlier symptoms included neck–shoulder pain, paresthesia radiating into the thumb, and prolonged functional limitation. Residual thumb numbness persists. These historical factors raise suspicion for traumatic neural involvement.
Ultrasound examination of the right shoulder was performed according to the ESSR shoulder protocol, including assessment of the rotator interval (SGHL, CHL), suprascapular nerve at the spinoglenoid notch, anterior/posterior/inferior labrum, and glenohumeral joint.
The primary imaging finding is dynamic subacromial impingement. The supraspinatus tendon demonstrates tendinopathy with thickening and altered echotexture. A type 3 (soft) calcification is present within the mid-portion of the tendon, further increasing tendon bulk.
There is mild to moderate distension of the subacromial-subdeltoid bursa.
During dynamic movement, the combined tendinobursal complex demonstrates friction against the acromion, consistent with subacromial impingement.
Clinically, glenohumeral or capsular pathology is suspected. Ultrasound findings are limited, but increased fluid within the biceps tendon sheath is present, serving as an indirect sign of intra-articular or capsular irritation.
Additionally, the suprascapular nerve appears thickened at the spinoglenoid notch. This may represent an incidental finding, but given the patient’s traumatic history and chronic symptom pattern, post-traumatic neuropathic change is a plausible explanation.
1. Final diagnosis
Subacromial pain syndrome caused by supraspinatus tendinopathy, type 3 calcific tendinopathy, and mild to moderate SASD bursitis with dynamic impingement. Additional indirect signs of glenohumeral/capsular irritation and possible chronic post-traumatic suprascapular neuropathy.
2. Differential diagnosis
Consider cervical radiculopathy or brachial plexus traction injury given prior neck trauma and persistent thumb sensory symptoms. Isolated incidental nerve thickening remains possible.
3. Teaching points
Shoulder pain may be multifactorial, combining mechanical impingement with neural or cervical contributors. Fluid in the biceps sheath is a useful indirect marker of intra-articular pathology. Suprascapular nerve abnormalities should be interpreted in the context of trauma history and muscle status.
4. Injury/disease information
Subacromial impingement results from reduced space between the rotator cuff complex and the acromion. Calcification and tendon thickening increase mechanical conflict. Traction or compression injuries of the suprascapular nerve may occur after shoulder trauma and can contribute to pain, weakness, or muscle atrophy.
5. Clinical correlation note:
Based on the provided history, a traumatic origin of at least part of the current findings appears plausible. The combination of prior shoulder/neck trauma, persistent neurological symptoms, and current suprascapular nerve thickening supports consideration of chronic post-traumatic involvement rather than a purely degenerative process.
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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