HSS Ultrasound of the Month Case #89

Clinical History 70 year old female with pain and poor range of motion 4 months after rotator cuff repair.

Ultrasound evaluation was requested to evaluate the integrity of the rotator cuff.

Ultrasound of the Month – Case 89

1

Ultrasound of the Month – Case 89

2

Ultrasound of the Month – Case 89

3

Diagnosis: Re-tear of previously repaired subscapularis tendon Discussion Ultrasound is an ideal modality for evaluating the rotator cuff tendons of the shoulder, with accuracy comparable to that of MRI according to many published reports.

The integrity of each of the four rotator cuff tendons is confirmed if a robust tendon is seen attaching to the greater or lesser tuberosities of the humerus on ultrasound.

In a full-thickness cuff tear, fluid is commonly seen replacing where a normal tendon is usually located.

In a shoulder with a previously repaired rotator cuff, suture anchor marking where the tendon was repaired is usually visible on ultrasound.

If there are no tendinous fibers attached to the suture anchor (i.e. a bare suture anchor), this is indicative of a re-tear.

Ultrasound is also the preferred modality under which an arthrocentesis is performed if there is concern that the rotator cuff re-tear is a result of an infection.

Ultrasound of the Month – Case 89

4