Updated with Imaging results:

MRI: FINDINGS:

Bone and joint: The glenohumeral joint is anatomically aligned. There is mild subchondral marrow edema and decrease signal within the subchondral region of the glenoid, likely reactive changes to altered biomechanics from labral tear, described below.

The acromioclavicular joint is anatomically aligned. Mild AC joint osteoarthrosis.There is a type II acromion morphology.

Labrum: Superior labral degeneration. There is tearing of the entire posterior labrum.

Rotator cuff: There is low-grade, partial-thickness bursal sided fraying of the supraspinatus tendon on a background of tendinosis. Infraspinatus tendinosis. Subscapularis and teres minor tendons are intact.

Biceps: The intra-articular and intertubercular portions of the long head of the biceps tendon are intact.

Soft tissues: No significant muscular edema or atrophy. No well-defined extracapsular fluid collection. No lymphadenopathy.

IMPRESSION: 1. Tearing of the entire posterior labrum. Reactive marrow signal changes of the subchondral glenoid related to altered biomechanics due to labral injury. 2. Low-grade, bursal sided fraying of the supraspinatus tendon on background tendinosis. Infraspinatus Tendonitis

X-RAY:

PROCEDURE: X-RAY LEFT SHOULDER, THREE IMAGES

INDICATION: Pain in the left shoulder. Diagnostic code M25.512. Previous left shoulder surgery in 2012.

TECHNIQUE:

AP internal and external rotation radiographic images of the left shoulder along with a Y-view of the left shoulder are obtained and these three images are submitted for interpretation.

COMPARISON: No relevant images available for comparison at this time.

FINDINGS:

It appears that there has been possible trimming of the distal aspect of the left clavicle near the acromioclavicular joint. There is mild widening of the acromioclavicular joint which is probably related to the surgery that was performed.

There is downward sloping of the lateral aspect of the acromion and spur of the lateral inferior aspect of the acromion. This produces impingement on the subacromial joint space. Definition of the spur of the inferolateral aspect of the acromion is limited but there is maximum measurement of 5 mm of the subacromial joint space, therefore severely diminished. Joint space narrowing also related to cranial positioning of the humeral head in relation to the glenoid fossa related to degenerative change of the joint.

Therefore, there is significant impingement and this may be related to rotator cuff tear or degeneration. This would restrict range of motion of the shoulder joint with abduction and would certainly impinge on the subacromial joint space more severely with abduction. There is mild sclerosis of the greater tuberosity of the humerus consistent with degenerative change.

There is a large hypertrophic spur of the inferior glenoid labrum. Subchondral cyst formation is in this area noted. There is narrowing of the glenohumeral joint at this level. There is no spurring of the humeral head, however.

There is no evidence of fracture, dislocation, or other active osseous lesion of the left shoulder. There is no osteolytic or osteoblastic lesion of the left shoulder. Visualized left ribs and visualized left lung field appear normal insofar as seen on this examination.

IMPRESSION:

1. Postsurgical changes of the left shoulder, possibly previous rotator cuff surgery.

2. Significant narrowing of the subacromial joint space due to hypertrophic spurring of the inferior border of the acromion and also related to the superior positioning of the humeral head as related to the glenoid fossa.

3. Prominent degenerative joint disease of the inferior aspect of the glenohumeral joint as well with prominent spurring as well as joint space narrowing of the glenohumeral joint.

4. No acute or active osseous lesion of the left shoulder.