Partial thickness partial width bursal aspect supraspinatus insertional tear on a background of subacromial impingement with thickened coracoacromial ligament indenting the supraspinatus tendon and large inferiorly projecting osteophyte from a degenerate AC joint indenting the supraspinatus musculotendinous junction. Effusion of the subacromial bursa with focal synovitis/debris within the bursal recesses anteriorly and posteriorly.