31-year-old patient presenting with shoulder pain during abduction and overhead activities. Symptoms likely activity-related
Ultrasound examination of the shoulder demonstrates moderate to severe tendinopathy of the supraspinatus tendon in the dysrepair phase. The tendon is thickened with reduced echogenicity and loss of the normal fibrillar architecture.
Within the mid-substance of the tendon, a small partial-thickness tear is identified, measuring approximately 2.8 × 2.6 mm. This appears as a focal hypoechoic defect without full-thickness discontinuity.
There is mild distension of the subacromial-subdeltoid (SASD) bursa, consistent with mild bursitis.
During dynamic ultrasound with guided active abduction, there is moderate primary subacromial impingement, with mechanical compression of the supraspinatus tendon and SASD bursa against the coracoacromial ligament and acromion.
1. Final diagnosis
Moderate to severe supraspinatus tendinopathy with a small partial-thickness mid-substance tear, associated mild SASD bursitis, and dynamic primary subacromial impingement.
2. Differential diagnosis
Consider articular- or bursal-sided partial tear not fully visualized, or isolated tendinopathy with focal degeneration.
3. Teaching points
Intratendinous tears can be subtle and should be differentiated from anisotropy. Tendon thickening combined with bursitis can reduce the subacromial space and lead to impingement. Dynamic ultrasound is essential to confirm functional impingement.
4. Injury/disease information
Supraspinatus tendinopathy is a common degenerative condition that may progress to partial tearing. Subacromial impingement results from a combination of tendon thickening, bursitis, and mechanical conflict during shoulder movement.
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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