Presentation
Restriction of movements
Patient Data
Rotator cuff and associated structures
Rotator cuff: thickened supraspinatus tendon with low grade partial thickness bursal surface tear. 10 x 7 mm intratendinous calcification. No tendon retraction. The subscapularis constituent of the rotator cuff is intact.
Bursa: mild subacromial and subcoracoid effusion.
Musculature: there is no muscle tear, contusion or atrophy.
Acromioclavicular joint: there are mild degenerative changes of the acromioclavicular joint. A type 3 acromion configuration is noted. There is anterior and lateral acromial downsloping.
Osseous structures
There are no fractures or regions of abnormal bone marrow signal intensity.
Long bicipital tendon
Biceps tendon is normally situated within the bicipital groove. No complete or partial thickness tendon tear is present.
Glenohumeral joint
Joint fluid: there is no glenohumeral joint effusion.
Cartilage and Bone: no focal hyaline cartilage defects are noted. No Hill-Sachs, reverse Hill-Sachs, or bony Bankart lesions are seen.
Conclusion
low grade partial thickness bursal supraspinatus tear with moderate calcific tendinosis
downsloping acromion with mild acrmioclavicular osteoarthritis causing extrinsic supraspinatus impingement
mild subacromial and subcoracoid bursitis
no labral or capsular/ligamentous injury
CT better delineates the calcification within the tendon.
Case Discussion
Heavy T2 signal loss focally within the rotator cuff tendon should raise the possibility of intra tendinous calcification. I often request for a frontal shoulder radiograph or a CT plain study to delineate the bony component.
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