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Rim rent supraspinatus tear

Case contributed by Doaa Faris Jabaz
Diagnosis almost certain

Presentation

Right shoulder pain.

Patient Data

Age: 50 years
Gender: Female
mri

An articular-surface tear with an intratendinous horizontal splitting centered at the supraspinatus footprint/tendon attachment to the greater tuberosity mainly anteriorly with extension into the critical zone. It has about 10mm AP dimension, and >3mm depth, involving more than 70% of tendon thickness. Coracoacromial arch evaluation reveals: a type 2 acromial process with lateral tilt, reduced impingement interval to 5.5-6mm, and underlying supraspinatus tendon thinning. A low lateral acromial angle <66 degrees.

Degenerative changes within the horizontal intra-articular portion of the long head biceps tendon just at/distal to biceps–labral anchor, with no complete tear.

An area of increased signal intensity at the base of the superior labrum was noted from 11:00-1:00 as compatible with the SLAP lesion possibly extending into the biceps anchor.

Case Discussion

Rim-rent tear/partial articular surface supraspinatus tendon tear with the features of subacromial impingement related to type II laterally tilted acromion, however subacromial impingement is a clinical diagnosis and one should not diagnose or exclude it solely based on imaging.

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