Hi Diane,
Personally I hate scanning reverse shoulder replacements!
I am not sure what we offer in the chronic pain setting,
By definition the cuff is usually severely damaged by the advanced OA disease that has led to the replacement in the first place.
In your case I must say that the cuff and associated muscles are in the best condition I have ever see.
Did this patient have the usual OA driven replacement or was this one of the rarer options like an avascular necrosis or trauma that led to the replacement.
If it is OA as the cause I am impressed by the quality of the cut and musculature.
Certainly if the LHBT is sublimed medially it does not necessarily cause muscle belly atrophy so the inbalance in size I would put down to muscle use patterns rather than atrophy. Atophy from a tendon rupture should always produce some increased echogenicity in the medium to long term.
I think the supraspinatus looks good for a post replacement cuff.
The AC joint is unlikely to be hydroxyapatite and more likely to be heterotypic calcification. If it is tender there may be some synovitis.
Your question about what we should be looking for in these patients is a question I wish I had an answer for. They are always tricky with the cuff being often extensively damaged from the OA. I just treat it like any post op shoulder and go through the cuff describing each component. The description is often “absent” !
Steve.