Persistent left shoulder pain The exam is limited by motion artifact and the patient's body habitus. There are multiple foci of signal void overlying the shoulder representing metallic susceptibility artifact from prior surgical intervention.ROTATOR CUFF: There is moderate fatty atrophy of the supraspinatus muscle. The distal fibers of the supraspinatus tendon are seen attaching to the greater tuberosity; however few if any of these fibers can confidently be traced to the atrophied supraspinatus muscle suggesting a high-grade and possibly full-thickness chronic tear of the myotendinous junction. There is mild fatty infiltration along the myotendinous junction of the infraspinatus but the tendon can be traced to its insertion upon the greater tuberosity. There is mild fatty atrophy of the teres minor muscle but the tendon can also be traced to its insertion on the greater tuberosity. The subscapularis muscle and tendon are normal.SUPRASPINATUS OUTLET: The acromion process is attenuated and there is widening of the AC joint compatible with prior surgery. There is no frank fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. Evaluation of the labrum is limited secondary to the lack of intra-articular contrast. We see no fluid-filled tear. There is no joint effusion.BICEPS TENDON: Evaluation of the long head of the biceps tendon is limited secondary to motion artifact. There is increased signal intensity of the tendon at its transition from the rotator interval to the intertubercular groove indicating tearing.
1. Surgical changes of subacromial decompression as detailed above.2. Fatty atrophy of the supraspinatus muscle with poor definition of the myotendinous transition suggestive of a chronic high-grade and perhaps complete tear at the myotendinous junction.3. Relatively mild fatty atrophy of the infraspinatus and teres minor muscles.4. Tearing of the long head of the biceps tendon at its transition from the rotator interval to the intertubercular groove.