Case Study: Missed Full-Thickness Rotator Cuff Tear

Our Patient

Our patient is a 79 year-old female whose son escorted her to our clinic. She was only able to lift her arm to about 30° before losing strength, and deep shoulder pain was shooting down to mid-arm.

The Challenge

Eight months earlier the patient had been diagnosed with “frozen shoulder” (aka adhesive capsulitis) by an orthopedist who made the diagnosis based on symptoms alone, with no exam or imaging.

Our Diagnosis

After reviewing her health history and conducting a physical exam, we used high-resolution diagnostic ultrasonography to visualize the patient’s arm and shoulder region.

Our findings:

• Passive ROM was partially limited, but not consistent with adhesive capsulitis.
• Ultrasound imaging revealed a full-thickness supraspinatus tear with retraction.
• The patient had severe glenohumeral osteoarthritis.
• Goutallier stage 3 fatty infiltration – a moderate-to-severe degree of fatty infiltration and muscle degeneration – of both the supraspinatus and infraspinatus muscles.
• Infraspinatus atrophy, likely due to suprascapular nerve traction plus disuse.

Discussion

Reduced shoulder range of motion does not always indicate adhesive capsulitis, and

structural causes must be ruled out. The delay in accurate diagnosis prolonged the patient’s suffering for eight months, and the condition no doubt worsened along the way. The delay could have been prevented if the original orthopedist had taken the time to conduct a hands-on physical exam and ordered imaging.