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Rupture of the long head of the biceps tendon frequently is encountered in the setting of coexisting rotator cuff pathology and chronic impingement, but traumatic rupture is occasionally seen, as in this case. Signs and symptoms are not always diagnostic, and MRI or MR arthrography can be a useful tool for evaluation of the tendon in difficult cases. Ideally, an empty bicipital groove is seen, indicating absence of the tendon and rupture. Scar tissue within the groove can be problematic, and correlation with oblique coronal and sagittal images is always recommended. The superior labrum at the attachment of the bicipital anchor should always be inspected carefully, as this is the most common site of rupture, and there may be an associated tear of the superior labrum. Magnetic resonance arthrography is not necessary for diagnosis in most cases, but will provide better visualization of the tendon and bicipital-labral complex.

Transient migratory osteoporosis is a self-limited disorder characterized by gradual onset of pain over several weeks to months and usually accompanied by characteristic findings on plain radiographs, scintigraphy, and MRI. Transient osteoporosis invariably resolves with conservative management, and therefore it is important to distinguish this uncommon syndrome from other disorders such as osteonecrosis, osteomyelitis, or infiltrative neoplasms, which require aggressive management. An accurate diagnosis of transient bone marrow edema syndrome or transient osteoporosis would lead to appropriate conservative management without biopsy, as in the case presented here.