Case study: Rotator cuff tear – Injection

A 46-year-old woman presented with chronic shoulder pain persisting for 8 months after a minor injury. Night pain and incidental pain during internal rotation and shoulder abduction were her main complaints. The pain primarily centered around the supraspinous fossa. The patient had no significant comorbidities or medical conditions.

Physical examination

• Painful arc present
• Positive Neer’s test
• Severe pain in the anteromedial shoulder on internal rotation

Ultrasound findings

• Cortical irregularity at the level of insertion of the supraspinatus tendon
• Synovial thickening and fluid collection in the subacromial bursa

Long axis view of the rotator cuff showing cortical irregularities and synovial thickening and fluid collection in the subacromial bursa.

• Subcoracoid bursitis

Short axis view of the rotator cuff showing subcoracoid bursitis.

Diagnosis
The patient was diagnosed with a rotator cuff tear, which occurs when one of the tendons in the rotator cuff becomes damaged and separates either partially or completely from the head of the humerus. The most common location for this tear is in the supraspinatus tendon, though other parts of the rotator cuff can also be affected. This injury can happen suddenly due to an acute incident or gradually over time due to repetitive use and aging. 

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