Case discussion
01Clinical context
A middle-aged patient presented with shoulder pain and underwent MRI to evaluate for rotator cuff pathology.
02Key imaging findings
MRI shows a focal full-thickness, partial-width tear of the anterior supraspinatus tendon at its humeral footprint measuring about 8 mm anteroposteriorly, with mild tendinosis. The posterior supraspinatus tendon fibers remain intact. There is mild infraspinatus tendinosis with a partial-thickness articular-sided tear of the distal tendon. Mild subscapularis tendinosis is present without discrete tear. Mild subacromial-subdeltoid bursitis and mild acromioclavicular joint osteoarthrosis with inferior acromial spurring causing mild outlet impingement are also noted. Mild tenosynovitis of the long head of biceps without tear or instability is seen.
03Diagnostic reasoning
The diagnosis was established on MRI by identifying a focal full-thickness tear limited in width at the anterior supraspinatus tendon footprint, best seen on coronal and sagittal fluid-sensitive sequences. The presence of mild tendinosis and associated bursitis was noted on T2-weighted images. The infraspinatus partial-thickness tear was characterized by articular-sided signal abnormality without full disruption. Evaluation of the acromioclavicular joint revealed osteoarthritic changes and inferior acromial spurring contributing to outlet impingement morphology.
04Questions for clinical practice
What is the significance of a partial-width full-thickness supraspinatus tear? Such tears can cause pain and dysfunction and may progress if untreated. How does mild acromioclavicular osteoarthrosis affect the shoulder? It can contribute to outlet impingement, worsening symptoms. When should follow-up imaging be considered? If symptoms persist or worsen despite conservative treatment, repeat MRI may be warranted. Does mild tenosynovitis of the biceps require surgery? Usually, it is managed conservatively unless associated with tendon tear or instability.
05Teaching point
Partial-width full-thickness tears of the supraspinatus tendon can be subtle but clinically significant. Careful assessment of the tendon footprint and adjacent structures on MRI is essential to identify these injuries, which may coexist with tendinosis and bursitis. Recognizing mild acromioclavicular osteoarthrosis and outlet impingement morphology helps guide management.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.
