Date : 00.00.00
Name of the Patient : Abc Xyzen Bhimjilmn / F / 92 yrs.
Referred by : Dr. Abc Xyzra / Dr. Abc Xyzatt.
Examination : M.R.I. of the Right Shoulder.
CLINICAL PROFILE :
C/O dislocation of the right shoulder since 14-15 days.
C/O inability to lift the RUE since then.
M.R.I of the right shoulder was performed using the following parameters :
5 mm thick T1 Weighted and GRASS (with fat saturation) axial images.
5 mm thick T1 Weighted and T2 Weighted (with fat saturation) sagittal images.
4 mm thick T1 Weighted, Proton and T2 Weighted coronal images.
There is evidence of an antero-inferior dislocation of the head of the right humeral head in relation to the glenoid cavity. Tear of the anterior and inferior labrum is noted with a probable fracture of the antero-inferior glenoid. There is loss of normal contour of the left humeral head with irregularity of its articular margin. A fairly large marginal osteophyte is noted along the postero-inferior margin of the right humeral head. The humeral head and proximal shaft show spotty fatty marrow changes suggesting osteoporosis.
There is seen a fairly large, loculated, fluid collection in the right shoulder joint. There is evidence of synovial thickening. Probable loose bodies/debris are noted in the right shoulder joint. The joint effusion is also seen to extend into the right
axillary region. The deltoid and the pectoral muscles are displaced away from the right shoulder joint.
Areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted and GRASS images are seen within the glenoid and proximal humeral shaft (? bone edema).
The supraspinatus muscle belly appears atrophied. It is difficult to appreciate the tendinous insertion of the supraspinatus tendon into the greater tuberosity of the humerus.
Degenerative changes are noted in the acromio-clavicular joint.
The acromion process is seen to be horizontally oriented.
The articular cartilage of the head of the right humerus appears thinned out.
The MRI features suggest anterior dislocation of the right humeral head in relation to the glenoid cavity, with anterior and inferior labral tear. A fairly large, loculated fluid collection with synovial thickening and debris/loose bodies is noted in the right shoulder joint. Significant degenerative changes are noted in the right humeral head.
The supraspinatus muscle is atrophied with a probable chronic tear of the supraspinatus tendon.
The above described changes may be secondary to severe osteoarthritis of the right shoulder joint. The possibility of this being an infective process (eg tuberculosis) cannot be entirely excluded, though less likely.