44-year-old patient presenting with left shoulder pain, with recent increase in symptoms and a history of trauma. Clinical evaluation is required to determine the relevance of imaging findings and to monitor for potential development of adhesive capsulitis.
Ultrasound examination of the left shoulder was performed according to the ESSR shoulder protocol, including additional evaluation of the rotator interval structures such as the superior glenohumeral ligament (SGHL) and coracohumeral ligament (CHL).
There is mild thickening of the subacromial-subdeltoid (SASD) bursa, most prominent in the rotator interval region, consistent with mild bursitis.
The supraspinatus tendon demonstrates mild tendinopathy, with slight thickening and subtle disruption of the fibrillar pattern.
A small to moderate calcification is present within the supraspinatus tendon.
Dynamic ultrasound assessment shows mild subacromial impingement, with the supraspinatus tendon and SASD bursa contacting the acromion and coracoacromial ligament during abduction. This is likely due to the combined effect of tendinopathy, calcification, and bursal thickening.
No additional significant abnormalities are identified.
It is important to note that the current imaging findings are relatively mild and may not fully explain the recent increase in symptoms.
1. Final diagnosis
Subacromial pain syndrome with mild SASD bursitis, supraspinatus tendinopathy, and intratendinous calcification causing mild dynamic impingement.
2. Differential diagnosis
Consider early adhesive capsulitis (frozen shoulder), particularly given the recent increase in pain and trauma history, despite limited current imaging signs.
3. Teaching points
Mild structural abnormalities on ultrasound do not always correlate with symptom severity. In cases with disproportionate pain, clinical reassessment is essential. Early frozen shoulder may present with limited imaging findings, requiring close clinical follow-up.
4. Injury/disease information
Subacromial pain syndrome is often multifactorial and may coexist with or precede other shoulder conditions. Adhesive capsulitis is a clinical diagnosis that evolves over time and may not be evident on early imaging. Monitoring range of motion is essential for early detection.
5. Clinical recommendation:
Correlation with clinical examination is essential to determine the relevance of the imaging findings. Given the recent increase in pain and history of trauma, it is advised to monitor glenohumeral range of motion over time to exclude early development of adhesive capsulitis.
If symptoms continue to worsen, an ultrasound-guided corticosteroid injection may be considered. Based on the current findings and clinical suspicion, a glenohumeral injection may be preferred to address a potential early capsular process, although final decision-making should be made by the treating physician.
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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