Subscapularis myotendinous junction tear - mimicry
Fell of bicycle and injured shoulder, no history of dislocation.
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There is an apparent near full thickness partial width articular surface tear of the subscapularis musculotendinous junction centrally. The arm is held in internal rotation and this may account for the apparent thickening and redundancy of the tendon footplate, which is intact. There is contrast in the anterior aspect of the subdeltoid bursa adjacent to the tendon tear. This could indicate a pinhole perforation at the above mentioned tear.
The supraspinatus is intact. The infraspinatus tendon is normal. There is no significant atrophy or fatty change of the rotator cuff muscle bellies.
The glenoid labrum is intact. There is a thickened middle glenohumeral ligament and mildly hypoplastic anterosuperior labrum in keeping with a Buford complex.
The biceps labral anchor is intact. There is mild intrasubstance signal within the biceps tendon intra-articular portion indicating mild tendinosis but the biceps tendon is otherwise normal. The tendon is well located in the bicipital groove.
There is mild stripping of the humeral attachment of the posterior band of the inferior glenohumeral ligament which is otherwise intact. The axillary recess and anterior band are normal. There is no Hill-Sachs lesion.
The glenohumeral joint is well aligned with normal chondral morphology. The AC joint has a normal alignment and morphology, with a type 2 acromion. The coracoclavicular and coraco-acromial ligaments are normal.
There is an apparent near full thickness articular surface tear of the mid substance of the subscapularis musculotendinous junction.
There is mild stripping of the humeral attachment of the posterior band of the inferior glenohumeral ligament. No ligamentous disruption is however identified.
Point of interest:
This case is interesing since when one over distends a joint during contrast infusion, or perhaps intentionally during therapeutic hydro-distension, one can see these findings in subscapularis.
We will never know whether she had a true tear or whether this was an iatrogenic phenomenon.