Rule out rotator cuff tear. Pain ROTATOR CUFF: Marked abnormality involving the supraspinatus representing a suspected full-thickness tear near the attachment with mild possible retraction of a proximally 1 cm, no clear fibers are observed through to the insertion. The remainder of the rotator cuff including the infraspinatus and subscapularis are otherwise intact and only demonstrate minimal tendinopathy. Minimal subdeltoid fluid.SUPRASPINATUS OUTLET: Mild narrowing with associated degenerative changes. See detail belowGLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritic changes are observed, with extensive progression of degenerative changes since prior study. Multiple subchondral cysts complicate the appearance of the humeral head with particular new abnormality involving the tuberosity. A small nondisplaced fracture fragment cannot entirely be excluded. Please correlate with physical exam and possibility of a subacute injury.Marked degenerative changes of the AC joint with underlying inflammation and small cysts or erosions.BICEPS TENDON: Tendon is grossly intact, no significant abnormality noted. ADDITIONAL
Marked interval changes most pronounced involving the greater tuberosity of the humoral head and AC joint. Given the past reported history of a fall and injury, a small subacute fracture cannot be excluded but the changes and distribution (although odd given the short period of time) additionally raise concern for an inflammatory process superimposed upon the rotator cuff abnormality involving the supraspinatus insertion.Dr. Purakel assisted in this discussion and EPIC history.