53-year-old patient presenting with shoulder pain and functional limitation. Symptoms likely related to rotator cuff pathology.
Ultrasound examination of the shoulder demonstrates severe tendinopathy of the long head of the biceps tendon, with slight fluid distension of the tendon sheath. There are no signs of neovascularization, suggesting a low-grade or non-active process.
The supraspinatus tendon shows a moderate full-thickness tear involving part of the tendon width (partial-width rupture). This is visualized as a focal discontinuity of the tendon fibers.
Additionally, there is a prominent cortical irregularity of the humeral head at the level of the infraspinatus tendon insertion. This may represent degenerative changes or sequelae of prior tendon pathology or traction-related remodeling.
No further details regarding infraspinatus tendon integrity are provided.
1. Final diagnosis
Moderate partial-width full-thickness tear of the supraspinatus tendon, with associated severe long head of the biceps tendinopathy and cortical irregularity of the humeral head at the infraspinatus insertion.
2. Differential diagnosis
Consider degenerative enthesopathy versus post-traumatic cortical irregularity at the infraspinatus footprint. Additional imaging may be considered if clinical suspicion persists.
3. Teaching points
Partial-width full-thickness tears are important to recognize as they may significantly impact function despite limited size. Mild biceps sheath fluid often reflects intra-articular or rotator cuff-related irritation. Cortical irregularities at tendon insertions may indicate chronic traction or degeneration.
4. Injury/disease information
Rotator cuff pathology frequently involves multiple structures. Supraspinatus tears are common and often coexist with biceps tendon irritation and degenerative bony changes at tendon insertions. These combined findings contribute to shoulder pain and dysfunction.
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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