Presentation
A male patient suffering from pain and limitation of shoulder movement. No traumatic event was recorded.
Patient Data
Around 20ml of contrast solution was administered directly into the left shoulder under flouroscopic guidance.
Optimal distension of the joint capsule is evident.
Linear T2W hyperintense area inside the distal supraspinatus tendon is noted, measuring around 15 mm in lenght, with no clear communication with joint space and subdeltoid bursa, all consistent with interstitial partial tear. There is no associated muscular atrophy.
Other rotator cuff tendons are intact. Small resorptive cysts inside humeral head near the attachment of infraspinatus tendon are visible.
No evidence of labral and long head biceps tendon pathology. Preserved cartilage of glenohumeral joint.
Mild degenerative changes of AC joint, with no secondary subacromial impingement.
Case Discussion
MR findings are consistent with partial interstitial tear of the distal supraspinatus tendon.
Partial tears of tendons of rotator cuff are more difficult to reliably detect on MR than full thickness tears. It is of greatest importance to recognize them, describe their extensiveness and potential communication with bursal or articular surface. Therefore, for better accuracy direct MR arthrography of the shoulder is advised.
Interstitial or intrasubstance tears have additional importance since they are not visible on arthroscopy and precedent MRI report could be declared as a false positive.
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