盂肱下韧带MR影像对冻结肩的诊断价值

目的探讨盂肱下韧带MR表现对冻结肩的诊断价值。方法分析我院间141例肩关节MR影像,将临床诊断为冻结肩48例患者作为冻结肩组、经关节镜证实的肩袖部分撕裂37例患者作为肩袖撕裂组、正常对照组56例。在斜冠状位T_2WI脂肪饱和序列上评估盂肱下韧带T_2信号强度、有无关节囊外高信号层并测量盂肱下韧带厚度。结果盂肱下韧带T_2WI脂肪饱和序列上呈高信号:冻结肩组41例、肩袖撕裂组5例、对照组5例,其诊断冻结肩的准确性88%、敏感性85%、特异性89%、阳性预测值80%、阴性预测值92%;斜冠状位T_2WI脂肪饱和序列上盂肱下韧带厚度:冻结肩组(n=48)(5.22±1.03)mm、肩袖撕裂组(n=37)(3.95±0.69)mm、对照组(n=56)(3.96±0.72)mm,冻结肩组厚度明显大于肩袖撕裂组、对照组,差异比较具有统计学意义(P0.001),肩袖撕裂组与对照组差异比较无统计学意义(P0.05)。结论盂肱下韧带T_2WI脂肪饱和序列上信号增高、增厚表现有助于冻结肩诊断。     

粘连性肩关节囊炎的MRI诊断

目的：探讨1.5 T MRI各扫描方位及序列对粘连性肩关节囊炎的诊断价值及其MRI特征性表现。方法：将临床确诊为粘连性肩关节囊炎的患者50例作为患者组（均为单肩,共50个肩关节）,纳入正常健康志愿者20例作为对照组（均为双肩,共40个肩关节）;观察2组肩袖间隙结构、下盂肱韧带结构分别在T₁WI、T₂WI、PDWI-FS序列,以及斜冠状位、斜矢状位、横轴位图像上的显示情况;分别计算MRI各扫描序列及方位对肩袖间隙结构异常和下盂肱韧带结构异常检出的敏感度、特异度、总符合率及约登指数,总结粘连性肩关节囊炎的特征性MRI征象。结果：患者组50例中47例（94.00%）肩袖间隙内见边缘模糊的片团影,均见下盂肱韧带肿胀增厚。对肩袖间隙结构异常的显示,斜矢状位诊断敏感度为84.00%,特异度为87.50%,总符合率为85.56%,约登指数为0.715,为最佳扫描方位;PDWI-FS序列诊断敏感度为94.00%,特异度为65.00%,总符合率为81.11%,约登指数为0.590,为最佳扫描序列。对下盂肱韧带结构异常的显示,斜冠状位诊断敏感度为78.00%,特异度为72.50%,总符合率为75.55%,约登指数为0.505,为最佳扫描方位;PDWI-FS序列诊断敏感度为96.00%,特异度为72.50%,总符合率为85.55%,约登指数为0.685,为最佳扫描序列。结论：PDWI-FS是MRI诊断粘连性肩关节囊炎的最佳扫描序列,斜矢状位及斜冠状位分别是显示肩袖间隙结构及下盂肱韧带结构的最佳扫描方位。肩袖间隙内边缘模糊的片团影及下盂肱韧带肿胀增厚是粘连性肩关节囊炎特征性的MRI征象,肩关节周围滑囊积液是粘连性肩关节囊炎的重要伴随征象。     

关节镜下Twinfix锚钉治疗肩关节Bankart损伤48例

肩关节是最不稳定及最常脱位的关节之一,占全部关节脱位的50％,一般人群发病率为2％.外伤所致的肩关节前脱位常导致盂肱关节前下方盂唇关节囊盂肱韧带复合体的附着处撕脱性损伤,称为Bankart损伤.发生率最高的肩关节脱位损伤为基于Bankart损伤的复发性肩关节前脱位[1].从关节镜下经肩盂下方打孔过线固定盂唇及关节囊的肩...     

肩关节CT造影与MRI造影诊断肩关节前脱位的对比研究

目的:探讨CT关节造影与MRI关节造影对肩关节前脱位的诊断价值。方法:对36例(36个患肩)肩关节前脱位患者分别行CT造影与MRI造影,比较2种检查方法对下盂肱韧带损伤、前下盂唇损伤、骨与软骨损伤的检出率,并与肩关节镜或开放手术检查结果对照。结果:36例(36个患肩)中,下盂肱韧带损伤24个(CT造影检出14个,MRI造影检出22个);前下盂唇损伤32个(CT造影检出27个,MRI造影检出30个);骨与软骨损伤30个,其中骨折18个(CT造影检出18个,MRI造影检出8个),骨挫伤10个(CT造影未检出,MRI造影检出10个),软骨损伤5个(CT造影未检出,MRI造影检出5个)。对下盂肱韧带损伤,MRI造影的检出率优于CT造影(P0.05);对前下盂唇损伤,CT造影与MRI造影检出率相似(P 0.05)。结论:对于肩关节前脱位的诊断,CT造影更利于发现骨折块,而MRI造影对观察骨挫伤及软骨损伤更有优势。     

磁共振成像在肩关节疾病诊断中的应用

肩关节是人体活动度最大也是最容易遭受损伤的关节。以往对肩关节疾病的诊断主要借助肩部X线平片和CT肩关节造影。随着磁共振扫描仪在肩关节的应用 ,使肩关节成像质量明显改观。尤其是常规磁共振成像 (MRI)和磁共振肩关节造影 (magneticreso nancearthrography ,MRA)技术 ,较之X线及CT肩关节造影能更清晰地显示软组织和骨的病变 ,特别是盂肱关节内的关节囊—盂唇—韧带结构。从而明显提高了对肩袖撕裂、盂唇病变等肩关节疾病的诊断正确率[1,10 ] 。1　肩关节解剖肩关节在大体上由盂肱关节和位于其上的喙肩弓构成。前者包括肱骨头、关节…     

MRI肩关节造影在肩袖间撕裂诊断中的临床应用价值

肩袖间隙(rotator interval)是指位于喙突外侧、肩胛下肌的上缘和冈上肌前缘之间的解剖间隙,联结冈上肌和肩胛下肌,间隙前方有喙肱韧带、盂肱上韧带使之得到加强,肱二头肌长头肌腱在其深面走行。肩袖间撕裂在常规MRI平扫时较难显示,MRI肩关节造影是目前诊断肩袖间撕裂的有效     

0.35T MRI在肩撞击综合征中的应用

目的 探讨0.35T MRI检查在肩撞击综合征中的应用.方法 对20例肩关节疼痛患者的MRI影像学资料进行分析.结果 磁共振成像显示冈上肌肌腱信号异常者5例,肩袖撕裂者6例,肩关节唇盂撕裂1例,关节囊及滑囊积液者4例,肱骨大结节陈旧性撕脱骨折者4例.结论 0.35T MRI能够清晰显示肩撞击综合征的影像特征,对于临床的诊断及治疗具有较大的价值.     

关节镜下自体复合补片移植联合肱二头肌长头腱重建上关节囊治疗巨大不可修复肩袖撕裂的疗效

目的探讨关节镜下自体复合补片移植联合肱二头肌长头腱重建上关节囊治疗巨大不可修复肩袖撕裂(IMRCT)的疗效。方法采用回顾性病例系列研究分析2020年5月至2022年6月蚌埠医科大学附属阜阳医院(阜阳市人民医院)收治的11例IMRCT患者的临床资料, 其中男7例, 女4例;年龄54～74岁[(62.6±7.3)岁]。患者均采用关节镜下自体复合补片移植联合肱二头肌长头腱重建上关节囊治疗。比较术前、术后6个月及末次随访时视觉模拟评分(VAS)、肩肱距离(AHD)、Constant-Murley评分、美国加州大学洛杉矶分校(UCLA)功能评分和肩关节主动活动度。末次随访时行肩关节MRI评估重建上肩关节囊和肱二头肌长头腱的完整性。观察术后并发症发生情况。结果患者均获随访13～39个月[16(13, 36)个月]。术后6个月, 肩关节VAS、AHD、Constant-Murley评分和UCLA功能评分分别为2(2, 3)分、(9.1±1.1)mm、(56.1±5.4)分、(19.7±2.8)分, 均较术前改善[6(5, 7)分、(5.1±1.2)mm、(37.9±2.2)分、(11.8±1.2)分...     

超声引导液压松解盂肱关节囊联合康复训练治疗冻结肩的临床效果

目的评价可视化超声引导下液压松解盂肱关节囊治疗冻结肩的有效性及安全性。资料与方法纳入55例冻结肩患者,其中Ⅰ期患者17例,Ⅱ期23例,Ⅲ期15例,在可视超声实时引导下,穿刺针经肩关节后斜上方路径液压松解盂肱关节囊,松解治疗后联合同步肩关节康复训练。初次治疗及末次治疗后4周应用肩关节功能评分(Constant-Murley)评定其治疗效果的有效性及安全性。结果55例冻结肩患者Constant-Murley评分均有效,其中评分为优37例,良18例。37例评优的冻结肩患者中,Ⅰ、Ⅱ、Ⅲ期分别为15例(88.2%)、13例(56.5%)、9例(60.0%)。18例评良的冻结肩患者中,Ⅰ、Ⅱ、Ⅲ期分别为2例(11.7%)、10例(43.4%)、6例(40.0%)。各期冻结肩患者治疗前后Constant-Murley评分比较,差异有统计学意义(P<0.05)。其中Ⅰ期冻结肩患者疗效显著,治疗后1周疼痛及关节活动度基本缓解,4周内症状基本消失。所有患者均在超声引导下一次性穿刺成功,治疗过程中所有患者均能耐受,未发生明显不适及并发症。结论超声引导下液压松解盂肱关节囊治疗冻结肩安全、有效,本穿刺路径治疗联合系统的肩关节康复训练有效提高冻结肩的治疗效果。     

肩关节疼痛的MRI检查价值评估

目的评价MRI检查对肩关节疼痛疾病诊断的应用价值。方法分析34例肩关节疼痛患者的MRI表现,并与手术所见相对比,评估MRI对疾病诊断的准确性。结果34例患者肩关节磁共振成像扫描发现:肩袖完全撕裂、肩袖部分撕裂、肌腱炎、盂唇撕裂、滑膜炎、关节积液、肱二头肌长头腱鞘炎及肌腱脱位、肿瘤等。13例手术,其中1例MRI诊断为肌腱炎,手术结果为肩袖浅表部分撕裂;1例MRI表现正常,关节镜发现肱二头肌长头肌腱炎,其余11例手术所见与MRI表现基本一致,另21例经保守治疗,症状消失或好转。结论肩关节MRI能清晰显示出肩关节的复杂解剖结构,对慢性肩关节疼痛的病因诊断有较高的准确性,是一项有价值的检查方法。     

The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder

The gross and histologic anatomy of the inferior glenohumeral ligament was studied in 11 fresh frozen cadaver shoulders. Arthroscopic observations of the joint capsule through the normal range of motion revealed that the inferior glenohumeral ligament is actually a complex of structures consisting of an anterior band, a posterior band, and an interposed axillary pouch. While these components of the inferior glenohumeral ligament complex were present in all 11 specimens, they were best demonstrated in some shoulders by placing the humeral head in internal or external rotation in varying degrees of abduction. Histologic examination of the joint capsule revealed that the anterior and posterior bands of the inferior glenohumeral ligament complex were readily identifiable as distinct structures comprised of thickened bands of well-organized collagen bundles. Although slight variations were noted in the attachment sites of the anterior and posterior bands to the glenoid, the inferior glenohumeral ligament complex was observed to attach to the humeral neck in one of two distinct configurations. A collar-like attachment, in which the entire inferior glenohumeral ligament complex attaches just inferior to the articular edge of the humeral head, was observed in six specimens. In the remaining five specimens, the attachment was in the shape of a "V," with the anterior and posterior bands attaching adjacent to the articular edge of the humeral head and the axillary pouch attaching at the apex of the "V" distal to the articular edge. The orientation and design of the inferior glenohumeral ligament complex supports the functional concept of this single structure as an important anterior and posterior stabilizer of the shoulder joint.     

Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture

Objectives

The aim of this retrospective study was to measure the inferior glenohumeral capsule thickness of shoulders clinically affected by capsular contracture by comparison to the contralateral asymptomatic side.

Methods

Bilateral shoulder ultrasound (US) examinations of 20 patients with clinically or MRI proven unilateral capsular contracture were retrospectively assessed. Inferior capsule evaluation was performed with a transducer placed within the axilla in maximally abducted shoulders. Measurements were symmetrically performed orthogonally to the inferior glenohumeral ligament (IGHL) in the axial plane; the coronal plane was used to ensure the tension of the IGHL. The significance of any difference in thickening was assessed with the Mann–Whitney test.

Results

The average thickness was 4.0 mm in shoulders with capsular contracture vs. 1.3 mm in asymptomatic contralateral shoulders (P?<?0.0001). Twenty per cent of patients with capsular contracture and inferior capsule thickness increase showed US features of other painful diseases of the rotator cuff.

Conclusion

The thickness of the inferior capsule is measurable through ultrasound examination and appears to be increased in shoulders with capsular contracture. Exploration of the inferior aspect of the shoulder joint could be added to shoulder US examination protocols for capsular contracture assessment even if other rotator cuff abnormalities are diagnosed by US.

Key Points

? Ultrasound is increasingly used to diagnose shoulder problems. ? The thickness of the inferior glenohumeral ligament is measurable in the axilla. ? The inferior glenohumeral ligament appears thickened in shoulders with capsular contracture. ? Capsular contracture ultrasound features can be associated with other rotator cuff problems.     

肩锁关节损伤影像研究

目的 探讨正常肩锁关节和肩锁关节脱位的影像表现. 方法 选取正常肩关节CR片68例、正常胸部正位CR片400例,测量肩锁关节间距距离和肩锁关节下皮质线关系.正常肩关节MRI 30例,临床证实肩锁关节脱位24例,肩撞击综合征7例,观察X线、MRI表现.结果 正常人肩锁关节间距为(3.36±0.44) mm;肩锁下皮质为一连续弧线.肩锁关节脱位24例中,按Rockwood分类,Ⅰ级7例,Ⅱ级5例,Ⅲ级12例;Ⅱ、Ⅲ级者肩锁关节间距增宽＞4.3 mm;Ⅲ级者肩锁关节下皮质弧线不连续.MRI发现Ⅱ级者关节软骨盘碎裂,关节囊和肩锁韧带撕裂,Ⅲ级者合并喙锁韧带撕裂.结论肩锁关节间距和下皮质弧线对诊断肩锁关节脱位分级有重要作用,MRI是确诊的有效方法.     

Posterior capsular fibrosis in professional baseball pitchers: case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit

In the high-performance athlete, acquired thickening of the posterior joint capsule is a proposed etiology for glenohumeral internal rotational deficit (GIRD). The purpose of this study was to present our MR arthrographic imaging observations of posterior capsular thickening in professional baseball players who present with reduced throwing velocity related to pain and clinical findings of internal rotational deficit of the glenohumeral joint. Our observations of MR imaging features in patients with clinical and arthroscopic manifestations of GIRD lesions include articular surface partial thickness tears of the supraspinatus and infraspinatus tendons, superoposterior subluxation of the humeral head and SLAP tears of the labrum. Although no empiric standard currently exists for the axial dimension thickness of the shoulder capsule, we have observed a thickened appearance of the posterior band of the inferior glenohumeral ligament in these patients.     

Acute instability of the shoulder in athletes. The role of magnetic resonance in therapy planning]

Magnetic resonance imaging (MRI) of the shoulder was performed to evaluate both the actual role of this technique in the study and staging of acute shoulder instability, and its potentials as diagnostic tool, with particular reference to treatment planning. Seventeen athletes with acute shoulder instability were examined. All MRI examinations, subsequent to plain radiographs, were performed within 48 hours from the traumatic event. After MRI examination, 14 patients underwent physiotherapy (2 cases were subsequently submitted to arthrotomy), and only 3 cases underwent surgical treatment in the acute phase (2 arthrotomies and 1 arthroscopy). These cases, submitted to MRI in the acute phase and subsequently to surgery, showed anterior glenoid labrum involvement with good evidence of associated skeletal lesions (Hill-Sachs lesions in 1); changes in the inferior glenohumeral ligament complex (2 cases) were also observed. In the other examined cases, MRI always provided accurate information on the glenoid labra and the anterior capsular mechanism. When the superior glenohumeral ligament was investigated (9 cases of 17), no alterations were observed. Acting as natural contrast, the presence of joint effusion allows good visualization, on T1-weighted sequences, of the structures involved by the traumatic events. Contrast resolution improvement could be obtained by employing gradient-echo T2 weighted sequences, which proved to be quite valuable for a correct depiction of the lesions involving the inferior glenohumeral ligament complex. In conclusion, MRI can be considered as a valuable diagnostic method for the early evaluation of the acute shoulder instability, since it provides information of the utmost importance for the subsequent therapeutical approach.     

Humeral avulsions of the inferior glenohumeral ligament complex involving the axillary pouch in professional baseball players

Introduction

Humeral avulsion of the inferior glenohumeral ligament is a rare injury in athletes and can involve different parts of the complex. Axillary pouch avulsion, in particular, has only recently been recognized in the literature, but has never been described in professional baseball pitchers.

Materials and methods

A retrospective review of professional baseball players presenting to our institution over 5 years was performed. Patients with Bankart lesions or fractures were excluded. Preoperative MRI was retrospectively correlated with the clinical and arthroscopic findings, as available.

Results

Four professional baseball pitchers were identified, all who had axillary pouch humeral avulsions of the inferior glenohumeral ligament. There was a concomitant avulsion of the anterior band in one patient. Associated findings included labral tears (n?=?2) and partial thickness tear of the rotator cuff (n?=?2). Three patients ultimately had their axillary pouch avulsions repaired at most recent follow-up.

Conclusions

APHAGL lesions can be seen in overhead athletes such as baseball pitchers and should be carefully considered as a potential cause of disability. Appropriate diagnosis is important to ultimately elucidate the optimal management of these lesions.     

Frozen shoulder: MR arthrographic findings

PURPOSE: To evaluate the magnetic resonance (MR) arthrographic findings in patients with frozen shoulder. MATERIALS AND METHODS: Preoperative MR arthrograms of 22 patients (six women, 16 men; mean age, 54.7 years) with frozen shoulder treated with arthroscopic capsulotomy were compared with arthrograms of 22 age- and sex-matched control subjects without frozen shoulder. The thickness of the coracohumeral ligament (CHL) and the joint capsule, as well as the volume of the axillary recess, were measured (Mann-Whitney test). Abnormalities in the CHL, subcoracoid fat, superior glenohumeral ligament, superior border of the subscapularis tendon, long biceps tendon, and subscapularis recess were analyzed in consensus by two blinded radiologists (chi(2) test). RESULTS: Patients with frozen shoulder had a significantly thickened CHL (4.1 mm vs 2.7 mm in controls) and a thickened joint capsule in the rotator cuff interval (7.1 mm vs 4.5 mm; P < .001 for both comparisons, Mann-Whitney test) but not in the axillary recess. The volume of the axillary recess was significantly smaller in patients with frozen shoulder than in control subjects (P = .03, Mann-Whitney test). Thickening of the CHL to 4 mm or more had a specificity of 95% and a sensitivity of 59% for diagnosis of frozen shoulder. Thickening of the capsule in the rotator cuff interval to 7 mm or more had a specificity of 86% and a sensitivity of 64%. Synovitis-like abnormalities at the superior border of the subscapularis tendon were significantly more common in patients with frozen shoulder than in control subjects (P = .014, chi(2) test). Complete obliteration of the fat triangle between the CHL and the coracoid process (subcoracoid triangle sign) was specific (100%) but not sensitive (32%). CONCLUSION: Thickening of the CHL and the joint capsule in the rotator cuff interval, as well as the subcoracoid triangle sign, are characteristic MR arthrographic findings in frozen shoulder.     

Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?

The success of arthroscopic capsular release of the glenohumeral joint depends on complete incision of the inferior capsule. This study determined the distance between capsule and the axillary nerve in different joint positions. In 14 human shoulder specimens the anterior joint capsule and axillary nerve were dissected, and the anterior joint capsule was incised between the 1 and 5 o'clock positions. The shortest distance between the insertion of the inferior capsule and the axillary nerve was measured at the glenoid and humeral insertions in abduction, adduction, internal, and external rotation. The axillary nerve is surrounded from soft connective tissue and is closer to the humeral than to the glenoidal attachment of the joint capsule. During abduction and external rotation the nerve stays in its position while the glenohumeral capsule tightens, which increases the distance between the two structures. This results in the following distances: to the glenoidal/humeral capsule insertion: in adduction and neutral rotation, 21.2+/-4.2/14.2+/-2.6 mm; in abduction and neutral rotation, 24.0+/-4.9/15.0+/-5.0 mm; in abduction and internal rotation, 21.1+/-6.6/14.6+/-3.7 mm; and in abduction and external rotation, 24.9+/-3.8/16.4+/-4.4 mm. Thus, when performing arthroscopic capsular release the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and externally rotated shoulder.