Myeloma with shoulder pain. X-ray shows stable myelomatous lesions of the left proximal humerus, but partial thickness tear seen on MRI of the left shoulder from May 2014. Reevaluate cause of pain. ROTATOR CUFF: There is thickening and increased signal intensity of the supraspinatus tendon indicating moderate tendinosis. Increased signal intensity along the bursal surface fibers of the posterior supraspinatus tendon at its insertion represents superficial tearing that appears similar to that seen on the prior study accounting for technical differences. Mild signal abnormality in the underlying greater tuberosity is likely degenerative in etiology and likewise appears similar to that seen on the prior study. There is mild fatty infiltration along the myotendinous junction of the supraspinatus, similar to that seen on the prior study. Tendinosis extends posteriorly to involve anterior fibers of the infraspinatus tendon, but I see no infraspinatus tendon tear. There is mild fatty infiltration of the myotendinous junction of the infraspinatus appearing similar to that seen on the prior study. The teres minor tendon and muscle appear normal. There is slight thickening of the subscapularis tendon suggesting mild tendinosis that has perhaps increased slightly when compared with the prior study. I see no subscapularis tendon tear, and the muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is moderate amount of fluid within the subacromial/subdeltoid and subcoracoid bursae with septations. Foci of intermediate signal intensity within the bursae likely represent a combination of synovitis and debris.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no large effusion. Intermediate signal intensity within the anterior and superior portions of the labrum likely represent degeneration.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular sulcus, suggesting mild tendinosis.ADDITIONAL
1.Progression of multiple myeloma compared with the prior MRI study.2.Rotator cuff tendinosis and partial thickness tearing as described above that appears similar to that seen on the prior study, although there has perhaps been slight increase in the degree of tendinosis of the subscapularis.3.Subacromial/subdeltoid/subcoracoid bursitis that has progressed when compared with the prior study.