Korean J Radiol.  2012 Feb;13(1):98-101. 10.3348/kjr.2012.13.1.98.

Occult Interpositional Rotator Cuff - an Extremely Rare Case of Traumatic Rotator Cuff Tear

• Lin CL
• Su WR
• Jou IM
• Chih WH

• KMID: 1058800
• DOI: http://doi.org/10.3348/kjr.2012.13.1.98

Abstract

Traumatic interposition of a rotator cuff tendon in the glenohumeral joint without recognizable glenohumeral dislocation is an unusual complication after shoulder trauma. Here we report the clinical and imaging presentations of a 17-year-old man with trapped rotator cuff tendons in the glenohumeral joint after a bicycle accident. The possible trauma mechanism is also discussed.

Keyword

Traumatic rotator cuff tear; Joint interposition; Posttraumatic subluxation; Shoulder dislocation

MeSH Terms

Adolescent
Bicycling/*injuries
Humans
Magnetic Resonance Imaging/*methods
Male
Range of Motion, Articular/physiology
Rotator Cuff/*injuries
Shoulder Dislocation/*diagnosis/etiology/rehabilitation

Figure

• 

  Fig. 1 Rotator cuff tendon interposition. A. Right shoulder X-ray reveals widened joint space and narrow subacromial space. B, C. MRI of right shoulder. Coronal, T2-weighted, fatsaturated sequence (TR 2000, TE 100) (B) shows supraspinatus defect and it is interposing in glenohumeral joint (asterisk). Parts of torn infraspinatus tendon (open arrow) were interposed into axillary pouch. Axial, T2-weighted, fat-saturated sequence (TR 2000, TE 100) (C) shows infraspinatus defect and soft tissues obliterating glenohumeral joint (double asterisk) and dislocated biceps long head tendon (solid arrow). D. Drawing demonstrating trauma mechanism. E, F. MRI of right shoulder. Coronal, T2-weighted, fat-saturated sequence (TR 2000, TE 100) shows bone edema over anterior part of humeral head (arrow in E) and acromion (arrowhead in F) after shoulder contusion during injury. HH = humeral head, ISP = infraspinatus tendon, SSP = supraspinatus tendon

Reference

1. Connolly S, Ritchie D, Sinopidis C, Brownson P, Aniq H. Irreducible anterior dislocation of the shoulder due to soft tissue interposition of subscapularis tendon. Skeletal Radiol. 2008. 37:63–65.

2. Rickert M, Loew M. Glenohumeral interposition of a torn rotator cuff in a young motorcyclist. Arch Orthop Trauma Surg. 2006. 126:184–187.

3. Shyam Kumar AJ, Charity R, Periera A, Deshmukh SC. Interposed subscapularis: a rare cause of irreducible shoulder dislocation. Eur J Orthop Surg Traumatol. 2005. 15:42–44.

4. Walch G, Boulahia A, Robinson AH, Calderone S. Posttraumatic subluxation of the glenohumeral joint caused by interposition of the rotator cuff. J Shoulder Elbow Surg. 2001. 10:85–91.

5. Mihata T, Doi M, Abe M. Irreducible acute anterior dislocation of the shoulder caused by interposed fragment of the anterior glenoid rim. J Orthop Sci. 2000. 5:404–406.

6. Davies MB, Rajasekhar C, Bhamra MS. Irreducible anterior shoulder dislocation: the greater tuberosity Hill-Sachs lesion. Injury. 2000. 31:470–471.

7. Bridle SH, Ferris BD. Irreducible acute anterior dislocation of the shoulder: interposed scapularis. J Bone Joint Surg Br. 1990. 72:1078–1079.

8. Tietjen R. Occult glenohumeral interposition of a torn rotator cuff. A case report. J Bone Joint Surg Am. 1982. 64:458–459.

9. Lo IK, Burkhart SS. Current concepts in arthroscopic rotator cuff repair. Am J Sports Med. 2003. 31:308–324.

10. Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge". Arthroscopy. 1993. 9:611–616.