55-year-old female with pain in the humerus and right shoulder 4 weeks not responding to physical therapy. No mass felt. Rule out rotator cuff pathology. RIGHT HUMERUS:The bone marrow signal intensity of the humerus is within normal limits. The musculature of the arm appears normal. There is fluid within the bicipitoradial bursa indicating a bursitis. Please note that this study was not protocoled for detailed evaluation of the distal biceps tendon. If there is clinical concern for distal biceps tendon pathology, MRI of the elbow could be considered. There is a small amount of fluid within the elbow joint.RIGHT SHOULDER:ROTATOR CUFF: On the coronal oblique fat saturated T2 weighted images, there is increased signal intensity within the distal fibers of the supraspinatus tendon and along the bursal surface fibers of the tendon. While on the coronal oblique images, these findings are suggestive of a high-grade partial-thickness tear, the increased signal intensity appears to extend through the entire thickness of the tendon on the sagittal oblique sequences, suggesting focal full-thickness disruption. Overall the tear is approximately 1 cm in the AP dimension. There is intermediate signal intensity within the adjacent supraspinatus tendon indicating moderate tendinosis. There is fatty atrophy along the myotendinous junction of the supraspinatus which otherwise appears normal. There are also small intrasubstance cysts along the myotendinous junction of the supraspinatus. There is intermediate signal intensity within the anterior fibers of the infraspinatus tendon indicating tendinosis. There is a collection of cysts extending along the myotendinous junction of the infraspinatus. There is mild fatty infiltration of the infraspinatus. There is intermediate signal intensity of the distal fibers of the subscapularis suggesting mild tendinosis with small cysts within the underlying humeral head. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small linear focus of fluid signal intensity within the posterior superior labrum suspicious for a small tear. The remainder of the labrum is unremarkable.BICEPS TENDON: There is increased intrasubstance signal within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove suggesting mild tendinosis.
1. Near full-thickness to full-thickness tear of the distal supraspinatus with tendinosis and intrasubstance cysts along the myotendinous junctions of the supraspinatus and infraspinatus.2. Osteoarthritis of the acromioclavicular joint.3. Probable small tear of the superior glenoid labrum.4. Mild tendinosis of the tendon of the long head of the biceps.5. Normal-appearing humerus and arm musculature.6. Bicipitoradial bursitis. Although we see no full-thickness tear of the tendon of the long head of the biceps, the study was not protocoled for detailed evaluation of the distal biceps tendon. If there is clinical concern for a partial thickness tear, MRI examination of the elbow could be considered.