Left shoulder pain and impingement signs for three month status post injection and physical therapy with no improvement. Years of subtle shoulder pain. Assess for massive rotator cuff tear. Evaluation of the shoulder on some sequences is limited by patient motion artifact.ROTATOR CUFF: The distal 2 cm of the supraspinatus tendon are of increased signal intensity with irregularity of both the bursal and articular surfaces indicating tendinosis and surface fraying/tearing. A poorly defined focus of increased signal intensity traversing the tendon at the 12-1-o'clock position approximately 2 cm proximal to its insertion on the greater tuberosity may represent a focal full-thickness tear, but I see no fluid-filled gap. There is mild fatty infiltration along the myotendinous junction of the supraspinatus muscle which otherwise appears normal. The infraspinatus muscle and tendon appear normal for age. The teres minor muscle and tendon appear normal for age. Increased signal intensity within the distal fibers of the subscapularis tendon suggests tendinosis, but I see no tear, and the muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a moderate amount of fluid within the subacromial/subdeltoid bursa indicating a bursitis containing multiple foci of intermediate signal intensity likely representing a combination of synovitis, debris, and perhaps also blood products.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small glenohumeral joint effusion. There is perhaps minimal osteoarthritis which is essentially within normal limits considering the patient's age. The superior labrum appears attenuated, likely reflecting chronic attritional tearing. There is also mild blunting of the anterior labrum likely representing degeneration.BICEPS TENDON: The tendon of the long head of the biceps appears normal for age.
1.Degenerated supraspinatus tendon with surface fraying/tearing and probable focal full-thickness defect, but I see no fluid-filled gap or massive cuff tear.2.Subacromial/subdeltoid bursitis as described above.3.Acromioclavicular osteoarthritis and other degenerative findings as described above.