Presentation
Pain in the shoulder with limitation of movement after a motor vehicle accident.
Patient Data
MRI direct arthrogram
20 ml of gadolinium contrast solution was administered directly inside the left shoulder joint under fluoroscopic guidance.
Optimal distension of the joint capsule is achieved.
A complete tear of the long head biceps brachii tendon is evident at the level of its intraarticular segment, with a consequent retraction of the distal part and a 3-centimeter-long gap formed.
Irregularity of the coracohumeral ligament is evident that is consistent with partial thickness tear.
High T2W signal intensity inside the distal supraspinatus tendon is noted, with no evidence of a tear, in keeping with tendiopathy. Moderate arthrosis of the AC joint is seen with a caudal osteophyte compressing supraspinatus myotendinous junction in keeping with secondary subacromial impingement.
A small effusion in the subdeltoid bursa is noted that does not communicate with the joint space.
Case Discussion
Complete tears of the long head biceps tendon (LHBT) are frequently associated with its previous degeneration and are commonly seen along a hypovascular segment of the LHBT found 1.2-3 cm from the tendon origin extending from the intra-articular portion of the tendon at the mid humeral head level into the superior portion of the intertubercular sulcus. This particular LHBT injury has been named the “groove entry lesion”.
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