23/12/2022 at 12:02 am #45352
Merry Christmas Steve, I’ve just scanned this chaps shoulder and I think I’ve found a quite large full thickness partial tear of SSP. I also found some significant effusion superior to the coronoid process which I’ve never come across before. I remember you mentioning effusion closer to the coronoid is more often joint effusion, I know the short head biceps tendon attaches around here too so what is it do you think?
PS thanks also to you and Son for the peroneal discussion/posts I hadn’t seen it until I’ve just logged on now. Interesting.
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23/12/2022 at 7:34 pm #45396
Oops, “coracoid” process,careless of me.
24/12/2022 at 8:46 pm #45422Stephen BirdKeymaster
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.
25/12/2022 at 3:22 am #45426
Thank you Steve, as always many thanks for your comprehensive help, I learn so much which gives me confidence and therefore enjoyment.
27/12/2022 at 10:12 am #45475Stephen BirdKeymaster
It is always my pleasure Mike,
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