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This patient is 44 years old.

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He's having pain during exercise.

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He does some weightlifting.

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We can see here on the left sagittal

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fat-suppressed weight sequences through the rotator

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cuff tendon attachment into the greater tuberosity.

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And what first jumps to our eye is, uh,

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an area of high signal intensity fluid,

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like signal intensity at the level of the footprint.

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I know I'm at the level of the footprint because

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we are seeing the greater tuberosity.

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I'm gonna outline the greater tuberosity for you right there.

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And then we see the cuff tendons attaching to it.

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Then at the level of the attachment, the ESIS,

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this would be the ESIS, the footprint.

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We see a focal area of fluid-filled defect in the

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anterior most portion of the rotator cuff.

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So that would be the supraspinatus tendon. Now,

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if we move on to the oblique coronal sequence,

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we are going to identify the anterior lineage of the

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RAs by looking for the long head biceps tendon.

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So we have the long head biceps tendon here going in between the lesser

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and greater tuberosities. And the next cut over,

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I'm having that area of, um,

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fluid-filled defect in the attachment of the supraspinatus.

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So let me just draw for you the greater tuberosity,

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the insertion and this area, which is the ESIS,

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is where the, um, defect is located.

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So we have a partial thickness tear of the supraspinatus

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tendon involving the footprint fibers with associated

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reactive edema.

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This is antipathy at the side of insertion of the tendon

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fibers. Now if we split the tendon into um,

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portions, we have the

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bursal side of the tendon, and here we have the attachment to the bone.

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So this would be the footprint.

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And then if we divide the thickness of the tendon,

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we can see that this defect is less than 50% of the tendon substance.

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So it's a low-grade partial thickness tear of the supraspinatus tendon

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comprising the footprint fibers.

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We know based on the oblique coronal sequence

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that it's the anterior lineage of that supraspinatus tendon that

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is affected.

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As I go back towards the attachment of the infraspinatus tendon,

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you can see a more normal

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rotator cuff morphology. So we have the articular surface,

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the footprint, the bursal surface, and it's low signal intensity.

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There is no defect in that location.

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There are some associated findings in this patient. He, as I mentioned,

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exercises routinely and does weightlifting.

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He has some edema in the distal clavicle with fluid in the acromioclavicular

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joint, only 44 years old.

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I always entertain the possibility that this is related to distal

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clavicle osteolysis in that setting. Just to use,

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here the coronal T1-weighted sequence, we see the fluid-filled defect,

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so it's that area in the supraspinatus tendon adjacent to the bone

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attachment where we have the partial thickness tear,

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comprising less than 50% of the tendon substance,

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hence low-grade partial thickness.