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Many images alert!
Hi Steve,
F/67 reports progressive increase in right shoulder pain and reducing ROM over 5wks.
Also has difficulty turning in bed, needs to support the back of shoulder.
No tenderness was elicited during dynamic study.
I tried my best to capture good images but the info has overwhelmed me!What are the findings here and how best do I express these findings in a report?
Any areas to improve my technique? -
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So much going on !
The long head of biceps tendon is slightly enlarged proximally and there is a small amount of fluid in the LHBT sheath. There is significant flow in the rotator cuff interval indicating a degree of glenohumeral joint synovitis. In this demographic it is less likely to be due to adhesive capsulitis and more likely due to OA and associated synovitis. A plain radiograph is recommended to assess the degree of OA changes and also screen for RA etc.
The areas you have measured in subscapularis are less worrying to me. The flat hypo echoic area at the enthesis is likely just an area of unosssified fibrocartilage hypertrophy as a response to traction loading and is not like to be a tear. The area measured in short axis may be a partial tear, but the multi-pennate nature of the tendon makes anisotropy very difficult to control across the tendon and it may be a little anisotropy artifact. Either way the subscap may have a small partial tear, but nothing too serious.The Supraspinatus is a bit of a mess, with a full thickness fissuring tear through the tendon in the area of the enthesis. It has multiple clefts and defects. If you place a needle int othis tear and inject a little lignocaine you will see it open up into a complex tear. Associated with this, as you would expect there is a small GH joint effusion and also some burial fluid.
The AC joint has degenerative OA changes and the joint capsule is swollen. The distal clavicle has significant bone remodelling raising the possibility of osteolysis changes. Again a plain radiograph will help. I suspect there is some synovitis of the AC joint as well.
Nice images mate.
Tge scap cyst is non specific. It has no sinister features and likely represents a dermal or hair follicle based collection
Steve
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