Severe shoulder pain and weakness with fall. Please evaluate for acute rotator cuff tendinopathy. ROTATOR CUFF: There are complete tears of the supraspinatus and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is thickening and increased signal intensity of the retracted tendons, but I cannot determine with certainty if this is due to chronic tendinosis, acute rupture, or a combination of the above. There is mild to moderate fatty atrophy of the infraspinatus muscle. There is also increased signal intensity within the supraspinatus and infraspinatus muscles on the fluid sensitive sequences which is nonspecific and could reflect subacute denervation or edema from an acute injury. The teres minor tendon and muscle appear intact. Although superficial fibers of the subscapularis tendon can be followed to their insertion on the greater tuberosity, there is delamination of the undersurface fibers of the subscapularis tendon with retraction medial to the glenoid. There is moderate to severe fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is fluid within the subacromial/subdeltoid bursa. The coracoacromial ligament is intact. The coracohumeral ligament is not well visualized and I suspect is torn.GLENOHUMERAL JOINT AND GLENOID LABRUM: Fluid within the glenohumeral joint communicates with that in the subdeltoid bursa via the aforementioned complete rotator cuff tear. Intermediate signal intensity within the superior labrum likely reflects degeneration/degenerative tearing. There also appears to be mild fraying of the anterior labrum. The humeral head is high riding with narrowing of the acromiohumeral interval to 4 mm, but glenohumeral joint alignment is otherwise within normal limits.BICEPS TENDON: There is dislocation of the tendon of the long head of the biceps medially from the bicipital groove with thickening and increased signal intensity of the tendon as it courses along the anterior aspect of the humeral head indicating severe tendinosis. It is difficult to confirm on this study whether or not the tendon attaches to the supraglenoid tubercle. ADDITIONAL
1.Complete and retracted tears of the supraspinatus and infraspinatus tendons as described above.2.Delamination and retraction of the undersurface fibers of the subscapularis tendon associated with dislocation of a degenerated biceps tendon as described above. I cannot determine with certainty if the biceps tendon attaches to the supraglenoid tubercle.3.Additional degenerative changes and other findings as described above.