I have no details…don’t know when the surgery was done, or what was done.
I believe there was probably a failed rotator cuff repair and a subsequent
graft type procedure…don’t know if it was a Superior Capsular
Reconstruction or some variation….I don’t see many.
I am confused by what I perceive to be a disconnect between the appearance
in the Cor and Sag plane:
[image: 54F chr pain RCR x 2 218164DIA.jpg]
I think the supra and infraspinatus tendons are chronically torn and
retracted ot the glenoid rim.
The red arrow shows something dark that is contiguous with the retracted
tendon (doesn’t go to the glenoid, ever, so I don’t think this is actually
a SCR), and the white arrows point to the medial edge of what may or may
not be the same graft????
[image: 54F chr pain RCR x 2 218164DIA (1).jpg]
[image: 54F chr pain RCR x 2 218164DIA (2).jpg]
[image: 54F chr pain RCR x 2 218164DIA (3).jpg]
[image: 54F chr pain RCR x 2 218164DIA (4).jpg]
I don’t clearly see discontinuity in the Sagittal…but I suspect I am
seeing it better in the Cor.
There is suture artifact…they didn’t use our Soft Metal Protocol…but I
am not convinced the artifact is all that limiting to warrant a call back.
I’m really hoping someone tells me how to report this.
3 thoughts on “54F Chronic Shoulder Pain s/p RCR x 2, MRI, Please Help”
hilary.umans
Diego Lemos answered my question brilliantly:
That’s probably a bridging graft, a technique that is used in some places
for “irreparable tears”; the difference with a SCR, as you pointed out, is
that the graft proximally is attached to the stump of the chronically
retracted cuff stump, not to the glenoid such as in SCR. In your current
case, I do believe there is a full-thickness midsubstance tear of the graft
proximal to its humeral insertion but distal to its cuff attachment, while
sometimes sutures of the graft to the anterior and posterior cuff can give
you apparent “pseudotears” this looks too wide and irregular. The other
possibility is that instead of a bridging graft this was an augmentation
graft that failed versus a variation technique of the above, I do however
favor the first possibility. Regardless, the construct is insufficient as
the humeral head is significantly translated superiority with narrowing of
the acromiohumeral interval, but you already knew that 🙂 🙂 🙂
[gallery]
hilary.umans
Final follow up on this case.
I spoke with the surgeon’s team and had them read me the op note.
This is a dermal graft from the stump to the humerus….so a bridging
graft, not a superior capsular reconstruction.
And I reported it as torn.
Case closed.
OCAD is great.
[gallery]
hilary.umans
Mohammad Samim was kind enough to share examples of a normal intact
superior capsular reconstruction on MRI, and examples of both glenoid and
humeral side attachment failure[image: SCR 2.jpeg][image: SCR Mohammad
Samim1.jpeg][image: SCR 3.jpeg][image: SCR 4.jpeg]
54F-chr-pain-RCR-x-2-218164DIA.pptx
That’s probably a bridging graft, a technique that is used in some places
for “irreparable tears”; the difference with a SCR, as you pointed out, is
that the graft proximally is attached to the stump of the chronically
retracted cuff stump, not to the glenoid such as in SCR. In your current
case, I do believe there is a full-thickness midsubstance tear of the graft
proximal to its humeral insertion but distal to its cuff attachment, while
sometimes sutures of the graft to the anterior and posterior cuff can give
you apparent “pseudotears” this looks too wide and irregular. The other
possibility is that instead of a bridging graft this was an augmentation
graft that failed versus a variation technique of the above, I do however
favor the first possibility. Regardless, the construct is insufficient as
the humeral head is significantly translated superiority with narrowing of
the acromiohumeral interval, but you already knew that 🙂 🙂 🙂
[gallery]
I spoke with the surgeon’s team and had them read me the op note.
This is a dermal graft from the stump to the humerus….so a bridging
graft, not a superior capsular reconstruction.
And I reported it as torn.
Case closed.
OCAD is great.
[gallery]
superior capsular reconstruction on MRI, and examples of both glenoid and
humeral side attachment failure[image: SCR 2.jpeg][image: SCR Mohammad
Samim1.jpeg][image: SCR 3.jpeg][image: SCR 4.jpeg]
[gallery]