Complete rotator cuff tear

Case contributed by Dr Utkarsh Kabra

Presentation

Pain with limited range of motion in right shoulder

Patient Data

Age: 65 years
Gender: Female
MRI

Complete tear of supraspinatus and infraspinatus tendons with superior migration of head of humerus, close to acromion.  Retraction of torn fibers is seen upto medial aspects of head of humerus and glenohumeral joint. Volume loss of supraspinatus and infraspinatus muscles is seen with grade II fatty atrophy (Goutallier classification).
Subscapularis tendinosis is seen with partial thickness undersurface tear of superior, mid 1/3 rd fibers involving approx. 40-50% thickness. Mild medial, interstitial extension of tear is seen.
Lateral downsloping, type II acromion is seen with small subacromial spur, mild acromioclavicular joint arthropathy, subtle subchondral marrow edema and
eburnation along articular margins.
Cortical irregularity with subtle marrow edema is seen along superolateral aspects of head of humerus.
Posterior subluxation of head of humerus is seen with significant degeneration of glenoid labrum. Glenohumeral articular cartilage is grossly intact.
Tendinosis of intracapsular segment of bicipital tendon seen.
Mild joint effusion with subacromial – subdeltoid and subcoracoid bursitis.

Case Discussion

Complete tear of supraspinatus and infraspinatus tendons with superior migration of head of humerus, close to acromion.  Retraction of torn fibers is seen upto medial aspects of head of humerus and glenohumeral joint. Volume loss of supraspinatus and infraspinatus muscles is seen with grade II fatty atrophy (Goutallier classification).

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