Presentation
Left shoulder pain. Cuff tear?
Patient Data
Mild medialisation of the proximal long head of biceps with high signal and thickening of the intracapsular portion.
Full thickness partial width superior third subscapularis tear with the stump reflected vertically passing lateral to the coracoid process into the suprascapular fossa ("comma sign").
Full width near full-thickness supraspinatus tear with the stump retracted to the level of the glenoid and appearing tendinopathic; a few posterior supraspinatus fibers appear continuous. Infraspinatus tendinosis without tear.
Reduced bulk of supraspinatus muscle belly (negative tangent sign) and the upper subscapularis muscle belly. No fatty atrophy.
Acromioclavicular joint osteoarthritis.
No glenohumeral joint effusion. Posterior labrum is irregular and high signal in keeping with degeneration.
Case Discussion
The comma sign of subscapularis tears occurs when the torn subscapularis fibers are retracted vertically by fibers adherent to a medially-displaced anterior supraspinatus tear.
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