Investigating Bicipital Tendinitis: Discovery of a Clinically Silent Full-thickness Supraspinatus Tear

Rotator cuff tears are frequently overlooked when imaging is not performed soon after trauma, allowing chronic changes to develop and secondary conditions to dominate the clinical picture. A 52-year-old right-handed female presented with severe right shoulder pain of 1-month duration that was initially attributed to isolated bicipital tendinitis. Detailed history revealed a remote motor vehicle accident evaluated only with plain radiographs. Magnetic resonance imaging (MRI) performed several years later demonstrated a complete full-thickness tear of the supraspinatus tendon with approximately 3.7 cm retraction of its fibres, Grade 3 Goutallier fatty atrophy, partial-thickness tear of the subscapularis tendon, tendinosis of infraspinatus and teres minor, acromioclavicular joint arthropathy with bursitis and mild capsular thickening suggestive of early adhesive capsulitis. A focused 3-week physiotherapy program combining pain-modulating modalities and progressive strengthening achieved complete pain relief (Visual Analogue Scale 8 → 0–1) and restored functional range of motion without surgery. Undiagnosed post-traumatic rotator cuff tears can remain quiescent for years and later present primarily as biceps tendon inflammation due to compensatory overload. This case reinforces the value of early MRI after significant shoulder injury and demonstrates that intensive, short-duration conservative treatment can yield excellent outcomes even when substantial retraction and fatty infiltration are present.