Rotator cuff tear

Case contributed by Maulik S Patel
Diagnosis certain

Presentation

Right shoulder pain, abduction weakness - few wks. No trauma.

Patient Data

Age: 60 years
Gender: Female
ultrasound

Symptomatic side shows absent biceps long head tendon in bicipital groove along with fatty infiltration - volume loss of its muscle belly favoring chronic tear of the long head biceps tendon. 

The symptomatic side supraspinatus tendon is replaced by a fluid cleft. Tendon retraction is about 37 mm. Anterior fibers of the infraspinatus tendon show a full-thickness tear. However, posterior fibers of the infraspinatus tendon are intact. 

There is mild volume loss and increased echogenicity ( fatty infiltration ) involving supraspinatus and infraspinatus muscles on the symptomatic side.

Asymptomatic side ( Examined for comparison ) shows normal findings - intact cuff. 

Subscapularis tendon - intact & normal echopattern.

Full-thickness & Full-width tear of the supraspinatus tendon.  Full-thickness tear of anterior fibers of infraspinatus tendon.

Volume loss as well as fatty infiltration involving supraspinatus and infraspinatus muscles on the symptomatic side as compared to asymptomatic side.

Case Discussion

Ultrasound findings show multiple tendon tear involving rotator cuff. Changes in muscle bellies ( volume loss and increased echogenesity ) suggest relatively chronic pathology.

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