Rotator cuff weakness. Evaluate for rotator cuff tear ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus and infraspinatus tendons indicating moderate tendinosis. Additionally, there is tearing and probably delamination of the bursal surface fibers of the supraspinatus tendon posteriorly beginning approximately 2.5 cm proximal to the tendon insertion on the greater tuberosity. I estimate this tearing to be approximately 1.5 cm in AP dimension and up to 2 cm in long axis. Along the majority of its length the tearing appears to involve approximately 50% of the tendon thickness although more focally there appears to be a small but near full-thickness defect with sparing of a thin layer of articular surface fibers. A small focus of increased signal intensity within the anterior fibers of the supraspinatus tendon at its insertion is suggestive of a tiny, possibly concealed insertional tear. Aside from mild fatty infiltration along the myotendinous junctions, the supraspinatus and infraspinatus muscles appear intact. The teres minor muscle and tendon appear intact. Thickening and increased signal intensity of the distal subscapularis tendon suggests tendinosis and perhaps mild interstitial tearing but I am not convinced that there is a full-thickness rotator cuff tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint with a small ossicle noted in the anterior aspect of the joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small glenohumeral joint effusion. Mild osteoarthritis affects the glenohumeral joint. There is intermediate signal intensity throughout the glenoid labrum compatible with degeneration and degenerative tearing. BICEPS TENDON: The extra-articular portion of the tendon of the long head of the biceps appears intact. There is a small amount of fluid in the biceps tendon sheath which may simply represent extension of fluid from the glenohumeral joint. The intra-articular component of the tendon of the long head of the biceps is difficult to visualize as the patient's arm is held in internal rotation; there appears to be mild increased signal intensity within intra-articular portion of the tendon indicating mild tendinosis.
1.Moderate rotator cuff tendinosis with a small, possibly concealed insertional tear of the anterior fibers of the supraspinatus tendon, with more extensive high-grade bursal surface tearing of the tendon more posteriorly and proximally, as described above.2.Osteoarthritis and degeneration/degenerative tearing of the labrum. Other findings as above.