Pain. Question of rotator cuff tear. ROTATOR CUFF: There is increased signal intensity and thickening of the supraspinatus and infraspinatus tendons indicating tendinosis. Furthermore, there is an insertional tear of the supraspinatus tendon that extends posteriorly to involve the anterior fibers of the infraspinatus tendon. This tear involves the bursal surface fibers but appears to spare the articular surface fibers. The tear involves greater than 50% of the tendon thickness. The tear is approximately 2 cm in the AP dimension. There is minimal, 3 mm, retraction of the torn bursal surface fibers. There is also lobulated fluid signal along the myotendinous junction of the infraspinatus which is compatible with an interstitial tear/cyst formation. The supraspinatus and infraspinatus muscles are otherwise normal. The teres minor muscle/tendon is normal. There is undersurface tearing of the distal subscapularis tendon at its insertion associated with biceps tendon dislocation, with what we believe to be delamination and proximal retraction of the undersurface fibers. There is mild atrophy of the superior fibers of the subscapularis muscle.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. There is fluid in the subacromial/subdeltoid bursa which is likely related to the aforementioned rotator cuff tears.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is mild blunting of the glenoid labrum but no discrete tear.BICEPS TENDON: The tendon of the long head of the biceps is dislocated medially from its groove and is perched on the lesser tuberosity. The tendon is indistinct at its transition in the rotator interval which we presume is due to tendinosis, although we cannot exclude the possibility of tearing.
1. Rotator cuff tears as described above with medial dislocation and degeneration of the tendon of the long head of the biceps.2. Additional degenerative changes as described above.