45-year-old patient with chronic shoulder pain

 

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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

 

Case Section

Muskuloskeletal System

 

Patient's Information

Gender : Male
Age : 45

 

Clinical Summary

45-year-old patient with chronic shoulder pain

 

Imaging Findings

Tear and retraction of superior fibers of subscapularis tendon(blue arrow) are demonstrated on T2- and fat-supp PD sequences .Bicipital groove is empty and long head of bicipital tendon(red arrow) is dislocated medially adjacent to the lesser tuberosity and torn fibers of subscapularis tendon.Remnant fibers of subscapularis tendon show interstitial tear at their attachment site on lesser tuberosity.Partial tear of the articular surface of supraspinatus tendon along with glenohumeral joint effusion are also seen.

 

Differential Diagnosis

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Final Diagnosis

Bicipital tendon dislocation

 

Discussion (Related Text)

Bicipital tendon dislocation usually occurs in conjunction with large, long-standing tears of the rotator cuff that have extended to include the biceps tendon pulley and the subscapularis tendon. The tendon dislocation may be overlooked clinically because the symptoms are masked by an associated cuff tear. Other lesions necessary for bicipital tendon dislocation to occur include disruption of both the strong coracohumeral ligament, an important stabilizer of the biceps tendon,and the weak transverse humeral ligament. In this setting, the tendon of the long head of the biceps dislocates medially, moving deep to the subscapularis tendon and muscle and into the glenohumeral joint, where it may be mistaken for a detached anterior labrum. In rare circumstances, when the subscapularis tendon remains intact yet the coracohumeral and transverse humeral ligaments are disrupted, the biceps tendon displaces extra-articularly and anterior to the subscapularis muscle. Occasionally, the biceps tendon lodges in the fibers of the distal subscapularis tendon .Besides allowing identification of the displaced biceps tendon, both CT and MRI show an empty bicipital groove.

 

References

Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009.

 

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