Hi Mike,
Great images,
This is a typical acute full thickness complete tear of the supraspinatus tendon.
There is no Supraspinatus left here, the material that may look like tendon is blood clot.
If you move the shoulder around or use transducer pressure you will see that it is a spongy mess of clot.
The fluid you are seeing near the coracoid process is bursa / joint fluid with some blood in it which is also clotted and hence the complex nature of the collection.
It is a mute point as to this fluid being either joint or bursal as the spaces are now communicating.
Fluid in that location I personally think is usually joint fluid, however I like to see other joint fluid in the LHBT sheath or axillary recess deep to terms minor to back up my argument.
This fluid has nothing to do with any injury of local structures at the coracoid process and is simply related to the acute supra tear.
I imagine the patient presented with an acute onset of pain following an action that tore the tendon (e.g. starting a lawn mower etc.)
The coracoid process is a fascinating little structure. As part of the scapula it is the anchoring point of many structures. If you stand in front of your patient and look at their right coracoid structure these are the structures which attach and their locations.
3 o’clock: Pec minor
6 o’clock: short head of biceps superficially and coracobrachialis beneath it
9 o’clock: coracohumneral ligament
10 o’clock: coracoacromial ligament
12 o’clock: the coracoclavicular ligaments (conoid and trapezoid)
It is a busy area,
Strangely enough we do not see failures of these structures often,. but occasionally we do so it is good to understand the anatomy.
I have been looking at the coracohumeral ligament origin recently in patients with GH joint synovitis or adhesive capsulitis. You can see it well with a bit of external rotation of the shoulder and then once I can see it well I release the external rotation and see it crinkle up, then put the SMI on it and look for flow.
It is another nice bit of evidence of GH joint inflammation.
Merry Christmas Mike, and thanks so much for your support and the excellent posts in 2022.
Steve.