Subscapularis tendon tear - the hidden lesion

Case contributed by Dr Andrew Lawson

Presentation

Left shoulder pain.

Patient Data

Age: 70 years
Gender: Male

The biceps tendon is markedly attenuated and subluxed medially into the superior fibers of subscapularis which themselves demonstrate marked thickening and interstitial high signal consistent with a high-grade partial -thickness tear. There is associated prominent fatty atrophy of the subscapularis muscle belly. The supraspinatus tendon is attenuated with a high-grade partial articular surface tear of the anterior half and a focal full-thickness tear through the posterior fibers measuring approximately 8 mm. Moderate fatty atrophy. The infraspinatus tendon demonstrates tendinosis of the level of the footplate.

Comment:  Partial-thickness articular surface tear of the anterior fibers with a small focal full-thickness tear of the posterior fibers of supraspinatus. Moderate fatty atrophy of the supraspinatus muscle belly. Medial subluxation of a severely attenuated biceps tendon with associated high-grade partial thickness tear of subscapularis.

Case Discussion

When the long head of biceps tendon subluxes medially, look for the subscapularis tear, which can often be overlooked and is this called a "hidden lesion".

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Case information

rID: 25297
Published: 18th Oct 2013
Last edited: 11th Sep 2019
Inclusion in quiz mode: Included

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