Rotator cuff tear diagnosed by conventional direct arthrography

Case contributed by Dr Ivan Turkalj

Presentation

A 70-year old patient suffering from shoulder pain after a fall 5 months ago.

Patient Data

Age: 70
Gender: Male
X-ray

Conventional direct arthrography

20 ml of iodine contrast solution was administered into the right shoulder joint under fluoroscopic guidance. 

Optimal distension of joint capsule is noted with even distribution of contrast material in the anterior and posterior shoulder recess. A spillage of contrast material from the joint space inside the subacromial-subdeltoid bursa is noted that speaks in favour of full-thickness tear of a rotator cuff tendon. 

Arrowhead shows the clear communication between the joint space and subacromial-subdeltoid bursa suggesting a full-thickness rotator cuff tendon tear.

Case Discussion

Conventional direct arthrography is usually performed prior to MR or CT exam in order to better depict subtle changes of cartilage and periarticular soft tissues. However, in case of gross pathology it could be used for making a definite diagnosis. 

Since subacromial-subdeltoid bursa does not normally communicate with the joint space, its depiction during arthrography is pathognomonic of full-thickness tear of a rotator cuff tendon.

 

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Case information

rID: 46244
Case created: 28th Jun 2016
Last edited: 1st Jul 2016
Inclusion in quiz mode: Included

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