Related Experiment Video
Updated: Mar 13, 2026
Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears
Published on: March 6, 2026
Delaminating infraspinatus tendon tears with differential retraction: imaging features and surgical relevance
Brady K Huang1,2, Eric Y Chang3,4
1Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
Objective:
To describe infraspinatus tendon injuries with associated intramuscular edema in light of more recently elucidated anatomical knowledge.
Material And Methods:
A retrospective review was performed to identify MRI cases with infraspinatus tendon injury accompanied by muscle edema. MR images were reviewed to evaluate the location of the injury, to assess the degree of tendon retraction, and to assess for muscular changes. Clinical and surgical data were reviewed when available.
Results:
Twenty-three patients were identified (13 males, 10 females, mean age of 52 years). MRI demonstrated infraspinatus muscle edema in all cases with variably retracted infraspinatus tendon fibers. Three patients (13 %) presented acutely after traumatic falls, 11 patients (48 %) presented after a minor trauma or recalled event, and 9 patients (39 %) presented with more chronic symptoms. Of the nine patients who underwent arthroscopic surgery, six patients (67 %) did not have an identifiable corresponding lesion, despite the findings described on the preoperative MRI. In these six cases, some superficial fibers of the transverse portion of the infraspinatus tendon remained intact on the MRI. Three patients (13 %) had follow-up MRI examinations with one progressing to severe muscle atrophy, one without progression of existing muscle atrophy, and one with no atrophy on the initial or subsequent evaluation. Eighteen of 23 patients had concomitant partial-thickness or full-thickness tears of the adjacent supraspinatus tendon.
Conclusion:
Injuries of the infraspinatus tendon with resultant muscle edema and variable muscle atrophy may, in fact, represent delaminating type injuries with differential retraction of a layered tendon and may be missed on arthroscopy.
Insights
Infraspinatus tendon injuries with muscle edema may be delaminating tears, potentially missed during arthroscopy. These injuries can lead to muscle atrophy and often occur with supraspinatus tendon tears.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- Infraspinatus tendon injuries are common causes of shoulder pain.
- Understanding the nuances of these injuries is crucial for accurate diagnosis and treatment.
- Recent anatomical insights prompt a re-evaluation of infraspinatus tendon pathology.
Purpose of the Study:
- To describe infraspinatus tendon injuries associated with intramuscular edema.
- To correlate imaging findings with anatomical knowledge.
- To evaluate the diagnostic accuracy of MRI compared to arthroscopy for these injuries.
Main Methods:
- Retrospective review of MRI cases showing infraspinatus tendon injury and muscle edema.
- Detailed evaluation of MRI for injury location, tendon retraction, and muscle changes.
- Review of available clinical and surgical data for correlation.
Main Results:
- Twenty-three patients (mean age 52) with infraspinatus muscle edema and variable tendon retraction were identified.
- Most injuries were associated with minor trauma or chronic symptoms.
- Arthroscopy missed corresponding lesions in 67% of surgically treated patients, with superficial fibers intact on MRI.
- Eighteen patients had concomitant supraspinatus tendon tears.
Conclusions:
- Infraspinatus tendon injuries with edema and atrophy may represent delaminating tears.
- Differential retraction of layered tendon fibers can occur.
- These injuries may be overlooked during arthroscopic evaluation.
