HISTORY:

This 40-year-old male presents with left shoulder injury.

PRIMARY FINDING:

Massive cuff contusion with bone fragmentation

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

A nondisplaced, fragmented greater tuberosity fracture is present with extensive osseous edema.

Severe rotator cuff contusion of the supraspinatus and infraspinatus distal insertions with interstitial tearing, tendinopathic changes and surrounding inflammation secondary to direct-impact injury. The distal attachments of the infra- and supraspinatus tendons are still intact.

Mild tendinopathic changes of the supraspinatus tendon at its distal insertion. Capsulobursitis secondary to the impact injury is present with fluid migrating into the subcoracoid space.

Long head of the biceps tendon is intact, as is the biceps labral anchor.

The glenohumeral is congruent. There is mild posterior sagging of the humeral head. Degenerative anterior and posterior labral tears are present.

Mild acromioclavicular joint arthropathy.

CONCLUSION:

1. Nondisplaced fragmented greater tuberosity fracture secondary to direct impact with traumatic cuff contusion involving the insertional portions of the supraspinatus and infraspinatus tendons with interstitial tearing, tendinosis and surrounding inflammation. Please note the tendinous attachments are still intact.

2. Mild insertional tendinopathy of the subscapularis tendon.

3. Degenerative labral tear.

4. Capsulobursitis with fluid extending into and distending the subcoracoid space.

Case Challenge

Cases

Lesson 2

Shoulder Pack 2

Case 2 - 40­-year­-old male presents with left shoulder injury

Case 2 - 40-year-old male presents with left shoulder injury