Subscapularis tendon tear - the hidden lesion
Left shoulder pain.
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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.
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".