Left shoulder pain. Assess for re-tear of rotator cuff. Evaluation of the humeral head and adjacent soft tissues is slightly limited by metallic susceptibility artifact related to recent surgery.ROTATOR CUFF: Since the prior study, the patient has undergone rotator cuff repair. There are multiple suture anchors in humeral head that extend to the surface of the greater tuberosity. One of the more posterior suture anchors appears to extend approximately 5 mm beyond the surface of the greater tuberosity, but the clinical significance of this is uncertain. Portions of the supraspinatus and infraspinatus tendons are visualized extending to these anchors. There is thickening and increased signal intensity of the posterior fibers of the supraspinatus tendon and anterior fibers of the infraspinatus tendon suggesting moderate to severe tendinosis. Small high signal intensity clefts vertically traversing the posterior fibers of the supraspinatus tendon and the anterior fibers of the infraspinatus tendon best seen on image 8 of series 1001 may represent very thin full-thickness defects, but I see no large fluid-filled gap or retraction of this portion of the cuff. More anteriorly, the insertional fibers of the supraspinatus tendon are indistinct on the coronal oblique fat suppressed T2 weighted sequence and I cannot determine if this represent additional tendinosis or perhaps insertional tearing filled with blood or granulation tissue. Nevertheless, I see no discrete fluid-filled gap. The supraspinatus and infraspinatus muscles appear normal. The teres minor tendon and muscle are intact. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle and acromion process that presumably reflects interval surgery. I otherwise see no abnormalities of the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa that could represent a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no frank effusion. There is mild blunting of the superior labrum that is new and may be due to interval surgery. The inferior labrum appears normal given the limitations of a non-arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps is visualized within the bicipital groove. It is not well visualized within the rotator interval; this may either reflect prior surgery or interval tearing.
Postoperative changes as described above including rotator cuff repair and possible bicipital tenotomy. The rotator cuff can be traced to its suture anchors within the humeral head. Heterogeneity of the cuff is most compatible with moderate to severe tendinosis, with smaller high signal intensity clefts within the cuff that may represent thin full-thickness defects, as well as poor definition of the most anterior fibers of the supraspinatus tendon that may reflect insertional tearing that could be pre-existing; however, I see no large fluid-filled gap or definable retraction of the tendon.