PMC3438862_01
Preoperative MRI: A, gradient echo T2-weighted axial image (S = subscapularis muscle). The humeral head is severely subluxed posteriorly. The subscapularis tendon is completely torn and retracted (large black arrowhead). The long head of the biceps tendon (black arrow) is dislocated medially, out of the bicipital groove (small white arrowhead). Extensive, amorphous low-signal tissue in the anterior joint is compatible with hemorrhage. B, fat-saturated T2 oblique coronal image (IS = infraspinatus muscle). The infraspinatus tendon is completely torn and retracted (small white arrowhead). There is also complete rupture of the teres minor with extensive fluid and hemorrhage in its expected position (large white arrowheads).
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The MRI also revealed complete, full-thickness tears of the supraspinatus and infraspinatus tendons from their insertions; a complete, full-thickness tear of the subscapularis with medial subluxation of the long head of the biceps tendon; and a probable full-thickness tear of the teres minor tendon (Figure 1).
Arthroscopic images: A, massive intra-articular hemorrhage and torn tendon edges; B, labrum intact circumferentially.
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An arthroscopic evaluation was therefore performed and so demonstrated the marked hemorrhage and edema in the glenohumeral joint (Figure 2).
Posterior approach. Upon reflecting the deltoid, the articular surface of the humeral head and torn infraspinatus tendon are visualized.
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The deltoid fascia was incised, and upon splitting the deltoid fibers, the posterior humeral articular surface was in direct visualization, confirming a complete avulsion of the infraspinatus tendon and disruption of the posterior capsule (Figure 3).
Postoperative MRI: A, T1-weighted oblique coronal image. Artifact from an anchor is present within the greater tuberosity (arrowhead). Note the intact supraspinatus tendon (arrow). B, gradient echo T2-weighted axial image. The subscapularis (black arrow) and infraspinatus (arrowhead) tendons are intact after repair (white arrow = artifact from anchor).
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The MRI, eventually performed nearly 3 months postsurgery, revealed a concentrically reduced glenohumeral joint with no evidence of persistent or recurrent rotator cuff tear (Figure 4).