Answers were C and B. The presence of an intramuscular intratendinous cyst typically means that there is an articular surface component. On this case the posterior coronal image shows it best I believe. Sometimes you don’t see it especially on routine MR but it is found at arthroscopy.
Thanks to Drs Golsaz, Crnkovich, Reveron-Arias, Rivero, AL Ismail, Rassie, Gottlieb, Schupak, Le Hir, Agarwal, Feng Pandley and Mink
Sanders TG, Tirman PF, Feller JF, Genant HK. Association of intramuscular cysts of the rotator cuff with tears of the rotator cuff: magnetic resonance imaging findings and clinical significance. Arthroscopy 2000; 16:230-235
Read More: www.ajronline.org/doi/full/10.2214/ajr.185.1.01850160 <www.ajronline.org/doi/full/10.2214/ajr.185.1.01850160>
Sometimes it is difficult to state the full extent of a rotator cuff tear. There are some findings that help with your confidence in deciding between a purely interstitial focal partial tear which may be treated conservatively (in some cases depending on the clinical factors) and articular surface tear which may be addressed surgically also heavily dependent on clinical factors.
How would you describe the supraspinatus and infraspinatus in the following case?
A. Normal
B. Focal interstitial insertional partial tear of the supraspinatus.
C. A partial tear with at least an articular surface component involving both tendons. Could be a focal full thickness perforation in there.
D.Through and through massive retracted tear.
E. Tendonitis that came from an over exuberant Pete Townsend windmill maneuver at the last holiday party.
What finding increases your confidence that there is a communicating articular surface component?
A. Fat Saturated proton density K space calculations.
B. Intramuscular/tendon cyst.
C. 6 cm’s of retraction.
D.The moderate joint effusion.
Please reply to me if you want to reply. I will tally up the last case responses shortly and send out. btw everyone got the answers correctly. I’ll also include a reference with the tally of this case.
