48 year old female patient with pain after 9 foot fall off ladder Evaluate for rotator cuff tear and biceps tear. There is a mildly displaced avulsion type fracture of the greater tuberosity with the fracture fragment measuring approximately 1.3 x 0.5 cm. The fragment is uplifted slightly by 7 mm by the supraspinatus tendon, separated by underlying bone with heterogeneous signal intensity which presumably represents fluid and blood products. There is edema within the underlying humeral head. We see no additional fracture.ROTATOR CUFF: The supraspinatus tendon can be followed to its insertion on the mildly displaced greater tuberosity fracture fragment. It appears thickened which is likely due to slight retraction and edema but we see no discrete full-thickness tear. The supraspinatus muscle is within normal limits. There is longitudinally oriented increased signal intensity along the undersurface fibers of the infraspinatus tendon near the posterior margin of the fracture fragment, which perhaps represents a shallow posttraumatic undersurface tear, but we see no full-thickness tear of the tendon. Thickening and increased signal intensity of the subscapularis tendon likely represents a combination of tendinosis and internal rotation of the humerus. The subscapularis muscle is within normal limits. The teres minor muscle and tendon are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa, which may be due to the aforementioned greater tuberosity fracture.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion. Mild osteoarthritis affects the glenohumeral joint. There is also increased signal intensity within the superior and anterior labrum which likely represents degeneration/degenerative tearing. BICEPS TENDON: Thickening and intermediate signal intensity in the biceps tendon within the intra-articular portion and transition to the intertubercular groove indicates moderate tendinosis, but we see no discrete tear. Small amount of fluid in the biceps tendon sheath may reflect extension of fluid from the glenohumeral joint.ADDITIONAL
1. Avulsion type fracture of the greater tuberosity as described above.2. Rotator cuff tendinosis and possible shallow undersurface tear of the infraspinatus, but no full-thickness rotator cuff tear.3. Tendinosis of the proximal tendon of the long head of the biceps without evidence of tear. The most distal portion of the biceps tendon is not included in the field-of-view; if there is concern for insertional injury, the patient may return for additional imaging.4. Mild osteoarthritis of the shoulder and degenerative labral tearing.