36-year-old male with right shoulder pain for the past 2 weeks after fall on an outstretched arm. ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus and infraspinatus tendons indicating mild to moderate tendinosis. There is a focus of fluid signal intensity within the anterior fibers of the distal supraspinatus tendon at its insertion, representing a tear that measures just under 1 cm in the AP dimension. This may represent a concealed tear as this does not definitively disrupt either surface of the tendon. It is associated with a cyst within the underlying greater tuberosity. There are additional smaller foci of increased signal intensity more proximally and posteriorly within the cuff which may represent small interstitial tears. The supraspinatus and infraspinatus muscles are otherwise within normal limits. There is mild increased signal intensity within the subscapularis tendon suggestive of mild tendinosis. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is edema within the distal end of the clavicle. There is a questionable cortical step-off along the anterior tip of the distal clavicle as seen on image 16 of series 8 which could represent a nondisplaced fracture, but this is equivocal. There are also small cysts within the distal end of the clavicle which can be seen as part of a stress reaction (osteolysis), particularly in patients that engage in weightlifting. There is also edema along the distal end of the clavicle which appears to undercut the acromioclavicular joint ligament. While it is possible that this could be due to a low-grade acromioclavicular joint separation, we see no edema within the acromion process or the coracoacromial ligament to suggest a higher-grade injury. There is a trace amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. Given the limitations of a non-arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: The long of the biceps tendon appears intact.
1. Edema within the distal clavicle and surrounding soft tissue as described above. These findings could reflect a nondisplaced fracture of the anterior tip of the distal clavicle, a low-grade acromioclavicular joint separation, posttraumatic osteolysis of the clavicle, or a combination of the above. Radiographs of the acromioclavicular joint may provide further information.2. Tendinosis and interstitial tearing of the supraspinatus and infraspinatus tendons as described above. Given the findings in the distal clavicle, these rotator cuff findings are not necessarily of current clinical significance.