Pain and weakness. Cannot hold arm up. Rule out rotator cuff tear. ROTATOR CUFF: There is a full-thickness near-complete to complete tear of the subscapularis tendon with retraction of the tendon to the level of the glenoid. Small foci of heterotopic ossification are seen within the retracted tendon. There is severe fatty atrophy of the subscapularis muscle. There is thickening and intermediate signal intensity of the anterior fibers of the supraspinatus tendon at their insertion indicating mild to moderate tendinosis. A tiny (2 mm) focus of high signal intensity within the bursal surface fibers of the anterior supraspinatus tendon insertion may represent a tiny insertional tear, but this is equivocal. More posteriorly, there is intermediate signal intensity along the undersurface fibers of the cuff at the junction of the supraspinatus and infraspinatus tendons measuring approximately 1 cm in diameter involving approximately 50% of the thickness of the tendon. I suspect that this represents an undersurface tear. Although the remainder of the infraspinatus tendon can be traced to its insertion on the greater tuberosity, the intramuscular portion of the infraspinatus tendon appears unusually thickened, and there is moderate fatty atrophy of the infraspinatus muscle; these findings may reflect an old tear that I cannot otherwise discern on this study. There is minimal fatty atrophy of the supraspinatus muscle. The teres minor muscle and tendon appear normal.SUPRASPINATUS OUTLET: There is a small amount of fluid within the acromioclavicular joint. Small osteophytes indicate mild osteoarthritis. I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the joint but no large effusion. Mild osteoarthritis affects the glenohumeral joint. Branching signal within the superior labrum indicates tearing which appears to extend into the superior half of the anterior labrum. A couple of tiny foci of intermediate signal intensity within the glenohumeral joint may represent small cartilage fragments.BICEPS TENDON: A structure of the intermediate signal intensity within the bicipital groove presumably represents the biceps tendon, but it becomes indistinct within the superior aspect of the groove and I see no definite tendon within the rotator interval nor do I see the biceps anchor. These findings suggest rupture of the tendon of the long head of the biceps in the absence of prior surgery.
1.Near-complete/complete full-thickness tear of the subscapularis tendon with retraction to the level of the glenoid. Additional tendinopathy/tearing of the supraspinatus/infraspinatus as described above.2.Osteoarthritis.3.Superior labral tearing.4.Rupture of the tendon of the long head of the biceps assuming no prior surgery.