This is the images from a 33 year old man who had surgery with some kind of capsulorrhaphy for multidirectional instability about 10 years ago. He did not improve much from that surgery, still a lot of problems with instability. He has made a lot of adjustments in his everyday life and has learned to live with his problems. He works as a plumber.
3 months ago he got a lot worse with onset of pain both at rest and at night. No trauma. Crepitus especially with internal rotation.
On ultrasound I could see signs of osteoarthritis but also a loose body in the rotator interval….
I sent the patient for X-ray mainly to see the extent of the OA but also to see if there were any other loose bodies that was hidden from me on ultrasound examination.
The X-ray came back saying he had no loose bodies at all!!?????
Obviuosly it was not that visiable with the bony background of the scapula…
So we ordered a CT confirming my findings and also that there wasn’t any other loose bodies…
The patient could of course have problems related to the OA but this loose body seems to be a big part of the problem, hitting the anterior glenoid when rotating the arm. He is now scheduled for arthroscopic removal of it. Hopefully that will make him a lot better…??