Don’t miss the extra-articular finding in this shoulder patient, otherwise ☠

This 58-year-old man has weakness and shoulder pain after a fall from a buggy. There is a finding at the edge of the film that is a can’t-miss in this case. Do you see it? What is also noteworthy?

Axial PD

Sagittal T1

Axial T1

Coronal T1

Sagittal T1

The finding you can’t miss is the discontinuity of the scapular body and fracture indicated on image 3. In the trauma setting, it’s always important to look for subtle fractures at the end of the film, as evidenced in this case. You should also make note of the bursal surface avulsion tear in the far anterior footprint, as seen by the arrows in images 4 and 5, and the periosteal edema separate from the joint space without extensive capsular injury (image 2, arrows). It’s this edema on image 2 that cannot really be explained by articular or rotator cuff pathology that’s “mission critical” in your visual analysis of this case. For more shoulder case review, visit MRI Online.

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