Presentation
Left shoulder pain and limited range of motion. A known case of diffuse large B-cell NHL, completed her chemo- and radiotherapy.
Patient Data
Obliteration of normal rotator interval fat by hypointense soft-tissue signal, poor definition of coracohumeral ligament, diffuse edematous/enhancing thickening of rotator interval capsule, the synovium, and inferior glenohumeral ligament at the axillary pouch capsule (>6 mm)
Coracoacromial arch assessment reveals:
type 3 acromion: hooked downward anteriorly with a small subacromial spur.
impingement interval (space between the coracoacromial arch and the superior aspect of the humeral head): reduced 5.5-6 mm with underlying supraspinatus tendon thinning and tendinopathic changes, more noticeable at the footprint, no intratendinous fissuring or tear
reduced lateral acromial angle <700, indicating down-sloping acromion with an upper normal acromion index of 0.7
minimal fluid in the medial extension of the subacromial-subdeltoid bursa with fluid tracking into and expanding the sub-coracoid bursa, no synovial thickening
Acromioclavicular joint (ACJ): normally aligned, minimal superior capsular thickening, no significant inferior osteophytes, and no os acromiale. Inferolateral ACJ configuration in the coronal plane.
Subcoracoid arch: normal coracohumeral distance, no feature of subcoracoid impingement, no displacement of the biceps pulley-anchor complex.
Glenohumeral joint: normal alignment of the joint without evidence of decentering. Normal conformity. No significant joint effusion.
Glenoid labrum: normal with intact anterior and posterior labra. SLAP type I: fraying of the superior labrum free margin, no paralabral ganglion formation. Anterior superior sublabral foramen (labral variant).
Biceps mechanism: the long head of the biceps tendon resides in the bicipital groove with intact labral anchor, horizontal, vertical, and genu portions.
Coracoclavicular ligaments: intact conoid and trapezoid ligaments.
Muscles: normal signal intensity and bulk for age, apart from volumetric loss at the supraspinatus belly without fat replacement.
Skeleton: normal configuration of the bones. Normal bone marrow signal without evidence of marrow replacing process, fracture, osteomyelitis, or osteonecrosis.
Subcutaneous/periarticular soft tissues: within normal limits.
Axillae: normal, no adenopathy.
Case Discussion
Imaging feature of adhesive capsulitis.
Subacromial impingement related to downsloping ACJ configuration, type III acromion and subacromial spur, insertional supraspinatus tendinopathy, and muscle belly volume loss with no tear. Minor fraying of the superior labral tissue at the 12 o'clock position.
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