48-year-old patient presenting with shoulder pain during abduction and overhead activities. Clinical history suggests a broader pathology, with possible glenohumeral instability based on anamnesis. Further clinical details not provided.
Ultrasound examination of the shoulder demonstrates findings consistent with subacromial pain syndrome (SAPS).
The supraspinatus tendon shows features of tendinopathy in the dysrepair phase, including thickening and altered echotexture. There is associated moderate subacromial-subdeltoid (SASD) bursitis, with increased bursal thickness.
The combined thickening of the supraspinatus tendon and SASD bursa results in reduced subacromial space. During dynamic ultrasound assessment with active abduction, there is clear evidence of primary impingement, with mechanical encroachment of the supraspinatus tendon and bursa beneath the acromion.
Based on the clinical history, there are additional concerns for glenohumeral instability. However, this is difficult to reliably assess with ultrasound alone and requires broader clinical and possibly additional imaging correlation.
1. Final diagnosis
Subacromial pain syndrome due to supraspinatus tendinopathy (dysrepair phase) with associated moderate SASD bursitis and dynamic primary impingement during active abduction.
2. Differential diagnosis
Consider partial-thickness supraspinatus tear, isolated bursitis, or internal impingement in the context of glenohumeral instability. Labral pathology or capsuloligamentous injury may underlie instability but are not well assessed with ultrasound.
3. Teaching points
Thickening of both the supraspinatus tendon and SASD bursa can contribute to mechanical subacromial impingement. Dynamic ultrasound during active abduction is essential to demonstrate functional impingement. Ultrasound has limitations in evaluating glenohumeral instability and intra-articular structures, requiring clinical correlation and possibly MRI.
4. Injury/disease information
Subacromial pain syndrome is a common cause of shoulder pain and is often multifactorial. Tendinopathy and bursitis can reduce the subacromial space, leading to mechanical impingement. In some patients, underlying glenohumeral instability contributes to altered biomechanics and secondary impingement.
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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