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So here we have a 69 year old shoulder pain,

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limited range of motion and throwing injury of almost two weeks ago

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with this case. We saw that, uh, you know, this, the tendons, uh,

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are basically, uh, we have a full thickness, uh,

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partial with tear at least of the, uh,

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supraspinatus and in infraspinatus tendon. And the other thing we have, uh,

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some of, some of you may have called like a small broad base, uh, suba.

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These fight.

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What you can see here is this little piece of extra bone that arguably is, uh,

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likely probably causing some, uh, uh, impingement, right? And,

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uh, impingement of the shoulder can be divided in,

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divided into two broad categories. What I want you to remember is, uh,

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internal and external impingement, okay? External impingement things causes,

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or you want to think of those, uh, things that, uh, can, uh,

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compress upon the, uh, part of the corco acromial arch. Okay?

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Um, or this, uh, half ring, if you will, uh,

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that can impinge upon the rotator cuff tendons. Okay? And working from a, uh,

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sort of anterior to posterior fashion, we can, uh,

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think about the corco process. We talked about that narrowing earlier. Okay.

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Other things that can cause narrowing, uh, of the, uh,

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this arch or this area are gonna be osteophytes from, uh, uh,

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inferiorly directed osteophytes from, say, severe, uh,

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acromioclavicular joint osteoporosis, other things that can cause, uh,

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impingement, uh, maybe like a thickened cortical, uh, humeral ligament, right?

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Other things are gonna be, uh, a type three, uh, or, uh,

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uh, or hooked acromion, uh, as we see here, in this case,

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a little bit of lateral downsloping as well in the coronal plane.

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Mind you though, some are, uh, some authors including Dr.

1:54

Gentilly from here at UCSD have, have shown that that has really not proven,

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uh, to pan out these, this lateral downsloping in the, uh,

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in the coronal plane. But, uh, for myself, if, uh, my surgeon is still,

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uh, worried about subacromial decom, uh, subacromial, uh,

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impingement or subcoracoid impingement, along those lines, I will offer, uh,

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a dynamic imaging under ultrasound. And again, I'll look for any bunching of,

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of the, uh, tendon otic, typically tendon or partially torn tendon,

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as well as bunching up of the, uh,

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subacromial subdeltoid bursa or even the subcoracoid bursa. Okay?

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And an abrupt release as the patient is ab ducted and a deducting

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their, uh, um, their shoulder to look for that sort of impingement. But here,

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just a nice case of a full thickness, uh, uh,

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tear of the supraspinatus and infraspinatus tendons,

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particularly centered at the, uh, junctional fibers here.

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And some of you nicely measured. The, uh,

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mentioned that the failure is at and near their footprint with arguably a few

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tendonous fibers still remaining

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Intact at their f plates or footprints.

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And then also accurately measured out this, uh, tendon tearing,

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which is, I don't know, about 22 or 23, uh, millimeters.

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And some of you also went and had and measured this, uh, tendon tear, uh,

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accurately for our surgeons, um, in the, uh,

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AP plane as well. And if I, if I had to, I'd probably measure it like this,

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something like that,

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and provide that information to the surgeon along with any, um,

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uh, muscle atrophy of the supraspinatus or involved muscle, uh, uh,

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muscle bellies of the respective tendons that were torn.

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So that's how I read this case. So basically, um, you know,

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full thickness tears of, of these tendons, as well as, uh, some, uh,

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impingement.

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There's also a little bit of tearing and tendonosis of the subscapular tendon.

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But, uh, arguably, obviously the main finding is gonna be this, uh, tendon tear,

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full thickness of, of the, uh, more superior, uh, tendonous, uh, uh,

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more superior rotator cuff tendons.