Happy New Year Steve
This is an acute and very restricted shoulder, insidious onset. Am I looking at a calcific tendinopathy of SSP? Also a SSC articular surface tear? Couldn’t get convincing images at the rotator interval except to say the LHB is intact. Is the uniform hypoechoic area (yellow arrow)a normal facial plane of deltoid or a bursosis?
There is certainly a small deposit of calcific tendinosis (hydroxyapatite) , however it is fairly small and I am not sure it is going to be causing the dramatic symptoms you describe.
The bursa is certainly very thick with bursitis.
I am not convinced about a subscapularis tear on your images.
Did they have any component of a frozen shoulder (adhesive capsulitis) clinically?
Sometimes when there is a hydroxyapatite deposit in a rotator cuff tendon it can leak out into the bursa. This creates an acute bursitis that is very painful. This would be another option.
Thanks for the feedback Steve, agreed the acute onset is unlikely caused by the calcium deposit and the bursitis and frozen shoulder more likely. I keep checking his external rotation and it is still okay but it remains a differential.