Female 44 years old Reason: Evaluate for impingement vs. rotator cuff tear History: Pain refractory to injectionsx2 Some sequences are slightly limited due to patient motion artifact.ROTATOR CUFF: Mild increased signal intensity within the supraspinatus tendon and anterior fibers of the infraspinatus tendon suggesting mild tendinosis, but we see no discrete rotator cuff tear. Mild fatty atrophy along the myotendinous junction of the supraspinatus and to a lesser degree the infraspinatus otherwise the muscles appear normal. Teres minor muscle and tendon appear intact. There may be mild fraying of the superior subscapularis tendon but this is of questionable clinical significance. Coracohumeral interval appears slightly narrowed raising possibility of subcoracoid impingement, though the clinical significance of this is uncertain. SUPRASPINATUS OUTLET: There is mild osteoarthritis affecting the AC joint. In addition there is broad-based prominence of the undersurface of the acromion process that could represent source of impingement with slight narrowing of the acromiohumeral interval and a small amount of fluid in the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Fluid signal intensity in the posterior superior labrum suggesting tear. The remainder of the labrum appears normal for age given limitations of a nonarthrographic study. Glenohumeral joint alignment is normal. We see no joint effusion.BICEPS TENDON: Given the limitations of a nonarthrographic study the long head of the biceps tendon appears normal although transition from the rotator cuff interval to the intertubercular groove is not well defined on this study.ADDITIONAL
1.Broad-based prominence of the undersurface of the acromion as well as small amount of fluid in the subacromial/subdeltoid bursa could reflect subacromial impingement; there is mild tendinosis of the underlying rotator cuff, but no tear is seen.2.Narrowing of the coracohumeral interval and equivocal fraying of the superior fibers of the subscapularis raising possibility of subcoracoid impingement but the clinical significance of these findings is uncertain.3.Tear of the posterior superior labrum.4.Loss of fat signal beneath the coracohumeral ligament has been described in patients with adhesive capsulitis.