Presentation
History of fall on the ground - 3 months ago. Complaining of loss of left shoulder overhead abduction.
Patient Data
There is mild reduction of the acromio-humeral space. There is subchondral sclerosis involving the acromion process of the scapula as well as the greater tuberosity of humeral head.
There is no fracture or dislocation. There is no soft tissue calcification.
Symptomatic LEFT shoulder :
- Non-visualization of supraspinatus - Infraspinatous tendons.
- Volume loss as well as fatty infiltration involving supraspinatus and infraspinatus muscle bellies.
- Intact biceps long head
- Intact subscapularis tendon.
Asympatomatic RIGHT shoulder :
- Cuff is normal and intact.
- Supraspinatus and infraspinatus muscle bellies are normal in echopattern and bulk.
Short axis view
The subscapularis tendon is seen medial to biceps long head. Supraspinatus tendon is not seen lateral to biceps long head tendon.
Longitudinal
- comparison of the supraspinatus muscle belly
- right asymptomatic - Normal
- left Symptomatic - Fatty infiltration, volume loss.
Longitudinal
- comparison of infraspinatus mucle belly :
- right asymptomatic - Normal
- left Symptomatic - Fatty infiltration, volume loss.
Longitudinal
- asymptomatic
- right - Supraspinatus tendon intact.
Case Discussion
An elderly male patient with a history of falls on the ground presents with a complaint of loss of left shoulder over-head abduction. Ultrasound shows non-visualization of supraspinatus tendon meaning retraction more than 30 mm. Infraspinatous tendon is also involved in tear. There is volume loss as well as fatty infiltration involving supraspinatus and infraspinatus muscle bellies.
The asymptomatic right cuff was examined for comparison. The right cuff is normal and intact. Right supraspinatus and infraspinatus muscle bellies are normal in echo pattern and bulk.
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