Supraspinatus tendinopathy

Together with a calcification and SASD bursa effusion

Clinical information

This patient had problems with overhead activities in daily life and work. Problems have gradually increased. The time of onset can not be remembered anymore, but is roughly 6 to 8 months ago. The patient has not changed his lifestyle, and is still fully functioning.

Brief description

Using the SonoSkills pathology checklist the following analysis was made of the supraspinatus (SSP) tendon and subacromial-subdeltoid (SASD) bursa.

  • SHAPE: the SSP tendon and SASD bursa have both increased in thickness. Together they measure 0.88 cm, in contrast to 0.5-0.7 cm averagely. This measurement has been done like this (from bone/cartilage to bursa/deltoid) since these two markers have maximum contrast in echogenicity, adding to the reproducibility/reliability of the measurement.
  • ECHOGENICITY: the SSP tendon is heterogeneous in echogenicity. A dark hypoechoic zone is seen mid tendon, surrounded with more hyperechoic parts. This hypoechoic zone looks like a degenerative tendinopathy. The tendon contains a specific hyperechoic zone that draws our attention. This zone shows an accoustic shadow which is strong at certain parts, but at other parts faint and even absent. This zone is 1.07 x 1.43 cm. It appears to be a calcification located in the posterior SSP tendon, a bit superficial to the humeral head, but more superficial to the anatomical neck and greater tubercle. The SASD bursa is filled the an anechoic bursal effusion.
  • CONTINUITY: the SSP fibre continuity appears to be intact, no disrupted fibres can be seen. We have to be careful since the tendinopathic zone is quite severe, and research has shown that it's not always that easy to differentiate, and clearly discriminate, a severe tendinopathy from a small partial tear.
  • DOPPLER: has been checked, but no signs of neovascularization can be seen.
  • FUNCTIONAL: No signs of an impingement could be seen during ultrasound guided active abduction/adduction. Be aware that the problem is located in the posterior SSP. In case of impingement, this would happen by the acromion. Acromial impingement of the posterior SSP is harder to detect than coracoacromial impingement of the anterior SSP.

Ultrasound Images & Clips

Transverse: power Doppler measurement SSP and SASD bursa
Transverse: power Doppler measurement SSP and SASD bursa
Transverse: measurement calcification
Transverse: measurement calcification
Transverse: measurement calcification
Transverse: measurement calcification
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades
Longitudinal: calcification in SSP with mixed acoustic shades

Conclusion

Based on the ultrasound findings and analysis we conclude:

  • Degenerative tendinopathy of the SSP
  • Calcification (1.07 x 1.43) cm in the posterior SSP
  • Effusion of the SASD bursa
  • No signs of neovascularization

Details

  • Sex: Male
  • Age: 44