Answer for BIR CoW 26 Jan 2025
Supraspinatus tear causing superior shoulder dislocation
Findings
XRAY- Superior dislocation of shoulder joint Reduced acromio-humeral distance
MRI - Discontinuity noted in the critical zone of supraspinatous tendon with retraction of myotendinous junction up to the level of lesser tubercle Postero superior migration of humeral head Mild joint effusion and distended subacromian and subdeltoid bursa
Impression: Complete Supraspinatus tear causing posterosuperior dislocation of shoulder.
Discussion
Rotator cuff disease is the most common causes of shoulder pain affect each one of the rotator cuff tendons and often more than one- supraspinatus tendon tear (most common), subscapularis tendon tear, infraspinatus tendon tear (second most common), teres minor tendon tear Causes of rotator cuff tendinopathy and tear -Acute and chronic trauma, Sports, overuse, Ageing, Collagen vascular disease , Metabolic disease, Vascular insufficiency leading to degeneration in critical zone[1cm from insertion site of supraspinatus] Location- Tendon insertion (footplate):degenerative Critical zone: degenerative or trauma-related Myotendinous junction: often trauma-related Findings- Reduced acromiohumeral Joint Space. Acromiohumeral Joint Space-Xray AP shoulder(distance between the inferior surface of acromion and articular cortex of the humerus).Normal-9mm Significance < 7 mm -rotator cuff tear or degenerative tendinitis caused by the unopposed action of deltoid, allowing superior subluxation of the humerus. > 11 mm- post-traumatic subluxation, dislocation, joint effusion,stroke,brachial plexus lesions(drooping shoulder) MRI- Increase in T2 signal intensity along with discontinuity or fraying of tendon indicates tear. Sometimes tears may not show T2 hyperintensity due to granulation or fibrosis.In such cases, Humeral head is apposed to acromion and T1 hyperintensity due to fatty atrophy of muscle belly noted. Other findings in complete RCT tear-Tendon retraction, loss of peribursal/subdeltoid fat plane,fluid in subdeltoid and subacromial bursa.
Findings
XRAY- Superior dislocation of shoulder joint Reduced acromio-humeral distance
MRI - Discontinuity noted in the critical zone of supraspinatous tendon with retraction of myotendinous junction up to the level of lesser tubercle Postero superior migration of humeral head Mild joint effusion and distended subacromian and subdeltoid bursa
Impression: Complete Supraspinatus tear causing posterosuperior dislocation of shoulder.
Discussion
Rotator cuff disease is the most common causes of shoulder pain affect each one of the rotator cuff tendons and often more than one- supraspinatus tendon tear (most common), subscapularis tendon tear, infraspinatus tendon tear (second most common), teres minor tendon tear Causes of rotator cuff tendinopathy and tear -Acute and chronic trauma, Sports, overuse, Ageing, Collagen vascular disease , Metabolic disease, Vascular insufficiency leading to degeneration in critical zone[1cm from insertion site of supraspinatus] Location- Tendon insertion (footplate):degenerative Critical zone: degenerative or trauma-related Myotendinous junction: often trauma-related Findings- Reduced acromiohumeral Joint Space. Acromiohumeral Joint Space-Xray AP shoulder(distance between the inferior surface of acromion and articular cortex of the humerus).Normal-9mm Significance < 7 mm -rotator cuff tear or degenerative tendinitis caused by the unopposed action of deltoid, allowing superior subluxation of the humerus. > 11 mm- post-traumatic subluxation, dislocation, joint effusion,stroke,brachial plexus lesions(drooping shoulder) MRI- Increase in T2 signal intensity along with discontinuity or fraying of tendon indicates tear. Sometimes tears may not show T2 hyperintensity due to granulation or fibrosis.In such cases, Humeral head is apposed to acromion and T1 hyperintensity due to fatty atrophy of muscle belly noted. Other findings in complete RCT tear-Tendon retraction, loss of peribursal/subdeltoid fat plane,fluid in subdeltoid and subacromial bursa.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!