Disclosures: Dhruvil Brahmbhatt, MD: Nothing to disclose

Case Description: The patient presented with a 5-month history of right shoulder pain and weakness following a jarring incident while being a passenger in a motor vehicle accident. She was referred for an ultrasound evaluation due to concern for a rotator cuff tear. She displayed profound right external rotation weakness, a drop-arm, and decreased shoulder range of motion, despite an otherwise normal neurologic examination.

Setting: Physical Medicine and Rehabilitation outpatient clinic.

Patient: 68-year-old female with suspected rotator cuff tear following trauma.

Assessment/Results: Ultrasound surprisingly revealed normal rotator tendons with no signs of tear. Further inspection demonstrated large myotendinous junction tears in both the supraspinatus and infraspinatus, located more proximally in their respective fossa, and outside of the typical windows for tendon visualization.

Discussion: Supraspinatus and infraspinatus myotendinous junction tears are rare relative to rotator cuff tendon tears. When present, they are often associated with minimal pathology of tendons, and could potentially be missed if not considered in the differential, or due to the use of a rigid, limited scanning protocol. This case highlights the importance of systematically inspecting all aspects of the rotator cuff complex, particularly in cases of prior trauma.

Conclusion: Myotendinous junction tears of the rotator cuff are rare but should be considered in the differential and part of the scanning protocol when assessing shoulder dysfunction.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-evaluation-of-a-complex-rotator-cuff-myotendinous-junction-tear/