Reason: eval rotator cuff History: R shoulder pain/weakness ROTATOR CUFF: Although fibers of the supraspinatus tendon can be followed to their insertion on the greater tuberosity, the tendon itself is markedly thinned, to the point of being barely perceptible just proximal to the greater tuberosity, suggesting chronic attritional tearing. Furthermore, the anterior fibers of the supraspinatus tendon are replaced with intermediate signal intensity at their insertion on the greater tuberosity, which we suspect represents a full thickness tear filled with granulation tissue. There is moderate atrophy of the supraspinatus muscle. The infraspinatus tendon can be followed to its insertion on the greater tuberosity, but there is moderate to severe atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. There is increased signal intensity within the distal fibers of the subscapularis tendon, suggesting insertional tendinosis. The subscapularis muscle is unremarkable.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is trace fluid in the subacromial/subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis affects the glenohumeral joint, with flattening and fragmentation of the humeral head medially, as well as with underlying signal abnormality in the marrow indicating osteonecrosis. Deformity of the humeral neck may also reflect sequela of old healed fracture. We see no glenohumeral joint effusion. There is degenerative tearing of much of the labrum. BICEPS TENDON: Evaluation of the tendon of the long head of the biceps is limited due to lack of intraarticular contrast, but the tendon is grossly intact.
1. Severe osteoarthritis of the glenohumeral joint with deformity and fragmentation of the underlying humeral head suggesting prior fracture and avascular necrosis. 2. Marked thinning of the supraspinatus tendon likely reflects chronic attritional tearing, with findings suspicious for full-thickness insertional disruption of the anterior fibers. 3. Other findings as described above. 