Presentation
Progressive shoulder pain; no history of trauma. Past history of backache (details not known).
Patient Data
There is a linear hypointense structure within the bicipital groove at anterior aspect of long head of biceps tendon. It is closely related to the supraspinatus tendon superiorly and appears to merge with pectoralis muscle/tendon inferiorly.
Multiple bony and enthesopathic changes:
cortical irregularity, erosions and marrow edema in distal clavicle (distal clavicular osteolysis).
mild marrow edema in acromion process, possibly along the attachment site of deltoid muscle. Edema is also seen in deltoid muscles / tendon.
erosions and marrow edema are seen in superolateral aspects of head of humerus along the insertion site of infraspinatus tendon (possibly Hatchet sign of ankylosing spondylitis).
supraspinatus and infraspinatus tendinosis is seen with no significant sizable tear.
mild edema is seen in supraspinatus, infraspinatus muscles and in coracoclavicular ligament complex.
Arrows pointing towards the aponeurotic expansion of the supraspinatus tendon.
Irregularity with erosions and mild marrow edema is seen along sacral and iliac articular aspects of right sacroiliac joint. Few erosions are also seen along iliac articular aspects of left sacroiliac joint with no significant marrow edema in present scan.
Case Discussion
Linear hypointense structure within the bicipital groove at anterior aspect of long head of biceps tendon is an anatomical variant, aponeurotic expansion of the supraspinatus tendon and likely an incidental finding. This should not be mistaken for a bifid long head of biceps tendon and more importantly an interstitial tear, hence, preventing unnecessary intervention.
Multiple bony and enthesopathic changes in shoulder with absence of any trauma or physical overactivity raise a suspicion of inflammatory arthropathy such as ankylosing spondylitis. This prompted us to image the sacroiliac joints.
Limited sequences of sacroiliac joints demonstrate right sided sacroilitis with minor changes on left side as well.
Follow-up for inflammatory arthropathy is awaited.
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