What’s the Diagnosis – Case 108
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Findings At the attachment or enthesis of the suprapspinataus (SST) there is tendinosis and a high grade partial tear and associated subacromial subeltoid (SA SD) bursitis. More prominent is irregular architecture of the infraspinatus (IST) tendon where there is discontinuity of a portion of a hyperintense tendon and prominent edema extending into the infraspinatus muscle belly.
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Diagnosis: Disruption of middle or central slip of the IST The infraspinatus tendon is one of many tendons that is multipennate in architecture. Although there can be variation there are typically three tendon slips. A tendinous or musculotendinous disruption of the middle or central slip is an uncommon cuff tear. The remainder of the tendon slips remain intact. As attention is typically drawn to the bony attachment or critical zone of the SST and IST it is important to not overlook this more medial process. In the literature this process is more typically described at the myotendinous junction and indeed some disruption occurs there. However, the vast majority of the pathology in this case and in the limited number of cases at our institution have involved the tendinous attachment with marked medial displacement. The thickness of the tendon relates to underlying tendinosis as well as the recent trauma.
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References Musculotendinous infraspinatus ruptures: an overview. Walch G, NovéJosserand L, Liotard JP, Noël E. Orthop Traumatol Surg Res. 2009 Nov;95(7):463-70. doi: 10.1016/j.otsr.2009.06.004. Epub 2009 Oct 8. A novel lesion of the infraspinatus characterized by musculotendinous disruption, edema, and late fatty infiltration. Lunn JV, Castellanos-Rosas J, Tavernier T, Barthélémy R, Walch G. J Shoulder Elbow Surg. 2008 JulAug;17(4):546-53. doi: 10.1016/j.jse.2007.11.016. Epub 2008 Apr 18.
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