Shoulder impingement syndrome: MR findings in 53 shoulders

The shoulder impingement syndrome refers to a condition in which the supraspinatus tendon and subacromial bursa are chronically entrapped between the humeral head inferiorly and either the anterior acromion itself, spurs of the anterior acromion or acromioclavicular joint, or the coracoacromial ligament superiorly. As a result, the space for the bursa and tendon is reduced, and repeated trauma to these structures leads to bursitis and rotator cuff injury. Although pain and limitation of motion are common early findings, the diagnosis is often delayed until a complete tear of the rotator cuff has occurred. In an attempt to determine if MR can be used to depict the abnormalities associated with impingement syndrome (subacromial bursitis, supraspinatus tendinitis, and rotator cuff tear), we reviewed 107 MR scans of painful shoulders. Changes consistent with impingement syndrome were found in 53 patients (50%), 32 of whom underwent subsequent arthrography or surgery. MR was found capable of depicting several soft-tissue and bony abnormalities that have been clinically described in impingement syndrome. In regions of inflammation, we found that the supraspinatus tendon and/or the subacromial bursa were compressed by spurs (25 shoulders), capsular hypertrophy of the acromioclavicular joint (six shoulders), and/or low-lying acromion (14 shoulders). While T1-weighted MR imaging was highly sensitive to abnormalities of the supraspinatus tendon, tendinitis could be differentiated from a small tear of the supraspinatus tendon only with T2-weighted imaging. Large, full-thickness tears, especially if chronic, produced characteristic MR findings on both T1- and T2-weighted images. We conclude that MR can be used to detect several abnormalities associated with the shoulder impingement syndrome.     

Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study

A prospective evaluation of the coexistence of calcific tendinitis and tear of the rotator cuff demonstrated by arthrography was made in patients presenting with shoulder pain. Patients were X-rayed using conventional views and impingement views. Eighty-one patients (mean age 61.2 years) with calcific tendinitis underwent arthrography. Arthrography showed 22 partial or complete tears of the rotator cuff. A small rather than a large amount of calcification was more likely to be associated with a rotator cuff tear (p = 0.005). The coexistence of calcific tendinitis with rotator cuff tear is not uncommon, especially in older age groups.     

肩关节损伤MRI与关节镜的对比分析

目的探讨常规MRI对肩关节损伤的诊断价值。方法回顾性分析因肩关节损伤行常规MRI和关节镜检查的55例病人资料,MRI观察指标包括肩袖、盂唇形态及信号,有否肩峰下撞击及骨性损伤。以肩关节镜为诊断金标准,统计MRI对不同类型肩关节损伤的诊断结果,并分别计算MRI的诊断敏感度、特异度和准确度。采用Kappa检验分析MRI与肩关节镜诊断结果的一致性。结果肩关节损伤的MRI征象中分别有25%部分肩袖撕裂、13.3%Bankart’s损伤、20%盂唇上部前后方向(SLAP)损伤和11.6%肩峰下撞击漏诊。MRI诊断损伤性病变的特异度及肩袖全层撕裂(100%)、骨性损伤(100%)、肩峰下撞击(88%)和Bankart’s损伤(87%)的敏感度较高,诊断SLAP损伤(75%)和肩袖部分撕裂(75%)的敏感度较低;诊断肩袖全层撕裂(100%)和骨性损伤(100%)的准确度最高,其次是Bankart’s损伤(96%),诊断SLAP损伤(89%)的准确度较低。MRI和关节镜诊断肩袖全层撕裂、骨性损伤的κ值为1,结果完全一致,诊断Bankart’s损伤的κ值为0.904,一致性较好,诊断肩袖部分撕裂、SLAP损伤和肩峰下撞击的κ值虽稍低,但均0.75,一致性也较好,P均0.05。结论 MRI是有效诊断肩关节损伤的影像方法,但对SLAP损伤和肩袖部分撕裂的诊断准确度有待提高。     

直接数字X线摄影对肩峰下撞击综合征的诊断价值

目的探讨肩关节正位、轴位、肩峰出口位直接数字X线摄影(DR)在肩峰下撞击综合征诊断中的意义。方法选取以肩部疼痛及活动受限为主诉的患者20例进行分析,其中男性13例,女性7例,右肩15例,左肩5例,分别摄取肩关节正位、轴位、肩峰出口位DR片,20例患者均行患肩关节磁共振成像(MRI)检查。结果 DR检查9例阳性患者,磁共振成像(MRI)检查均可见肩袖表面毛糙、部分或全层撕裂,而DR检查阴性患者仅1例可见肩袖损伤。结论肩关节正位、轴位、肩峰出口位DR对诊断肩峰下撞击综合征具有病因学意义。     

Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder

The usefulness of ultrasound measurements in the diagnosis of the subacromial impingement syndrome of the shoulder was evaluated. Fifty-seven patients with unilateral symptoms of the impingement syndrome underwent ultrasound examination of both shoulder joints, which included assessment of rotator cuff integrity, measurement of rotator cuff thickness and the distance between the infero-lateral edge of acromion and the apex of the greater tuberosity of humerus (AGT distance) in the standard ultrasonographic positions. As a control group, 36 volunteers (72 shoulders) with no history of shoulder pain were examined sonographically. Ultrasonographic assessment of humeral head elevation, measured as the AGT distance, proved to be useful in establishing the diagnosis of the subacromial impingement syndrome of the shoulder. A difference in rotator cuff thickness of more than 1.1 mm and a difference in the AGT distance of more than 2.1 mm between both shoulder joints may reflect dysfunction of rotator cuff muscles.     

肩关节损伤的MR影像诊断

目的 探讨常规MRI和MR间接关节造影对肩关节损伤的诊断价值.方法 回顾分析经关节镜证实的90例肩关节损伤患者肩关节常规MRI和MR问接关节造影表现,其中肩袖病变组57例、盂肱关节不稳组33例.对常规MRI和MR间接关节造影诊断结果进行Fisher确切概率法比较.结果 (1)肩袖病变组中MR间接关节造影37例,显示部分撕裂10例,1例漏诊;显示完全撕裂17例,2例误诊,7例肩袖无撕裂.MR间接关节造影显示部分撕裂的敏感度、特异度、准确度分别为90.9%(10/11)、92.3%(24/26)、91.9%(34/37);显示完全撕裂的敏感度、特异度、准确度分别为89.5%(17/19)、94.4%(17/18)、91.9%(34/37).MR间接关节造影诊断肩袖部分及完全撕裂的敏感度及准确度均高于常规MRI(P<0.05).(2)盂肱关节不稳组中,盂唇损伤26例,Hill-sachs病变27例、反Hill-sachs病变2例、骨陛Bankart损伤7例、关节囊损伤18例.间接关节造影20例,显示盂唇损伤14例,1例漏诊,5例正常.MR间接关节造影显示盂唇损伤的敏感度、特异度、准确度分别为93.3%(14/15)、100.0%(5/5)、95.0%(19/20).前者诊断盂唇损伤的敏感度及准确度明显高于常规MRI(P<0.05).结论 MR检查特别是MR间接关节造影能够准确显示肩关节常见病变及相关组织的病理发展过程,为临床诊断及治疗提供影像学依据.     

Shoulder MRI after impingement test injection

Objective. To determine how long injected fluid from an impingement test remains in the bursa or adjacent soft tissues after an injection. Design and patients. Six patients prospectively underwent MRI of the shoulder immediately before and after an impingement test injection, and at 3 days, 2 weeks and 4 weeks later. MR images were evaluated and graded for fluid distribution within the bursa and adjacent soft tissues. The rotator cuff was evaluated for signal abnormalities related to the injection. Results and conclusion. Three days after the injection, the soft tissue fluid had returned to pre-injection levels or less in five of the six patients. No patients showed rotator cuff signal abnormalities related to the impingement test injection. We recommend a delay of 3 days before a shoulder MR examination after an injection has been performed, to avoid misinterpretations.     

Rotator cuff coactivation ratios in participants with subacromial impingement syndrome

Coactivation of the rotator cuff is vital to glenohumeral joint stability by centralising the humeral head within the glenoid fossa. Yet in individuals with subacromial impingement, it is hypothesised that rotator cuff coactivation abnormalities are present that could contribute to their shoulder pain. The purpose of this study was to determine if abnormal rotator cuff coactivation and deltoid activation patterns exist in participants with subacromial impingement. Rotator cuff (supraspinatus, infraspinatus, and subscapularis) coactivation and middle deltoid activation was assessed during an elevation task. ANOVA models were used to compare muscle activation patterns in 10 participants with subacromial impingement and 10 control participants. Participants with impingement exhibited decreased rotator cuff coactivation (subscapularis–infraspinatus and supraspinatus–infraspinatus) and increased middle deltoid activation at the initiation of elevation (0–30° of humeral elevation). The participants with impingement also had higher subscapularis–infraspinatus and supraspinatus–infraspinatus coactivation above the level of the shoulder where pain is typically present (90–120° of humeral elevation). The results indicate that individuals with subacromial impingement exhibit rotator cuff muscle coactivation and deltoid activation abnormalities during humeral elevation that might contribute to the encroachment of the subacromial structures associated with subacromial impingement.     

The active abduction view: A new maneuvre in the diagnosis of rotator cuff tears

The plain film views of the shoulder in the case of a fresh rotator cuff tear are usually normal. Reduction of the space between the under surface of the acromion process of the scapula and the humeral head occurs only in late, neglected cases. A new projection is described, the active abduction view of the shoulder, where in many patients with a complete rotator cuff tear the humeral head is closely apposed to the acromion, obliterating the subacromial space. In such a situation, the medial portion of the torn rotator cuff retracts during active abduction, allowing approximation of the two bones.     

肩袖破裂的影像诊断

肩袖，又称旋转肌袖，对肩关节起主要的稳定作用。肩袖破裂为肩部疼痛的主要原因之一，但在临床上许多病例往往被误诊为肩周炎，而Ｘ线平片又不能很好地显示肩袖发生的病变。笔者通过对５１例肩痛患者肩关节造影和造影后ＣＴ扫描检查，发现肩袖完全破裂１０例，部分破裂７例。认为，肩关节造影为诊断肩袖破裂的重要方法，ＣＴ肩关节造影不仅能提高诊断正确率，而且能提供更多的病变情况，有利于决定手术和手术方法的选择。     

肩关节冈上肌出口位X线摄影在肩峰下撞击综合征中的应用价值

目的:探讨肩关节冈上肌出口位X线摄影所示肩峰形态、肩峰下间隙与肩峰下撞击综合征(shoulder impingement syndrome,SIS)的相关性,总结其临床应用价值。方法:回顾性分析60例经临床证实的SIS患者的临床及影像资料,对X线摄影所示的肩峰形态及肩峰下间隙进行分型、测量,并与MRI所见进行对照,分析肩峰形态及肩峰下间隙与SIS的相关性。结果:60例患者中,肩峰平坦形(Ⅰ型)8例、弧形(Ⅱ型)10例、钩状(Ⅲ型)42例。冈上肌出口位X线摄影所示肩峰下间隙为(1.21±0.36)cm,MRI所示肩峰下间隙值为(1.10±0.18)cm,两者差异无统计学意义(P0.05)。肩袖损伤MRI分级Ⅰ级27例,Ⅱ级20例,Ⅲ级13例。肩峰下间隙值与肩袖损伤MRI分级呈正相关(P0.05)。结论:肩关节冈上肌出口位X线摄影所示肩峰形态、肩峰下间隙与SIS发生密切相关;当肩峰形态为钩状及肩峰下间隙值1cm,强烈提示SIS可能,对于无MRI的基层医院诊断SIS临床意义明显,值得临床应用。     

Impingement of the rotator cuff in athletes caused by instability of the shoulder joint

An impingement of the rotator cuff can be caused by chronic anterior instability of the shoulder joint. This particular disease is often found in athletes engaged in overhead motion in abduction/external rotation of the arm, such as in ball sports like volleyball or European handball, racket sports like tennis or badminton, or swimming. For those patients that cannot be cured by conservative treatment such as muscular stabilization, surgical treatment is indicated: anterior reconstruction of the capsule and/or the glenoid labrum, and in addition — if necessary — subacromial decompression and revision of the rotator cuff. Between October 1988 and April 1992, we operated on 66 shoulders in 64 top athletes suffering from chronic anterior or multidirectional instability of the shoulder joint that had caused an impingement syndrome of the rotator cuff. In all cases, the athlete was unaware of the instability. Conservative treatment had been unsuccessful. Surgical treatment was successful in close to 90% of the athletes.     

肩关节造影和MRI诊断肩袖损伤

目的评定肩关节造影、MRI诊断肩袖损伤的价值.材料和方法将33例临床诊断肩袖损伤患者的术前关节造影和MRI检查结果与术中观察结果的比较.另有13例复发性肩关节不稳、无肩袖损伤症状和体征的年轻患者术前的关节造影和MRI结果以及术中观察结果作为正常肩袖对照.结果在诊断肩袖完全断裂中,肩关节造影的敏感性为91%,特异性为100%;MRI的敏感性为95%,特异性为88%.结论关节造影诊断肩袖完全撕裂方法简单、迅速且费用低,易于广泛开展.但不能直接显示病变部位.MRI不但能够准确显示断裂的部位,反映肩袖病变的病理过程,而且能同时显示相邻组织的病理改变,更利于诊断和鉴别诊断.     

External impingement of the shoulder

The relationship between external shoulder impingement and rotator cuff disease has been the subject of much research, but the theories of cause and effect remain controversial. Patients with symptoms of external impingement are referred for imaging to identify bony abnormalities of the coracoacromial arch and associated bursal and rotator cuff disease. Attempts have been made to identify objective imaging criteria that confirm the diagnosis of impingement, but at present external impingement remains primarily a clinical diagnosis. Therapeutic management varies from rehabilitation with physiotherapy to surgical procedures aimed at decompressing the subacromial space and repairing rotator cuff tears. This article reviews the relevant anatomy, biomechanics, and theories of external impingement, the role of imaging in the diagnosis of external impingement and rotator cuff disease, and implications upon management.     

肩袖撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对肩袖撕裂的诊断价值。方法 分析32例病人的肩关节MR造影图像,评价内容包括肩袖肌腱、盂唇、肱二头肌长头腱,结果与肩关节镜及肩部开放手术比较。结果 以肩关节镜和手术结果为标准,32例病人包括14例全层撕裂,6例下表面部分撕裂,12例无撕裂。肩关节MR造影判定有无肩袖撕裂的敏感性、特异性和准确性都为100％;诊断全层撕裂的敏感性、特异性和准确性分别为100％、94％和97％。同时,肩关节MR造影还正确诊断了所有的多肌腱撕裂、合并的盂唇异常及肱二头肌长头腱异常。结论 肩关节MR造影可以准确、全面地评价肩袖撕裂。     

Multimodality imaging of the postoperative shoulder

Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach.     

Shoulder arthrography with sodium meglumine metrizoate and iopamidol

The purpose of this study was to analyze arthrographic imaging of the structures of the shoulder joint when using either sodium meglumine metrizoate or iopamidol as a contrast medium. Two hundred and ten patients underwent single-contrast shoulder arthrography. In patients with a full-thickness tear of the rotator cuff, both contrast agents reliably revealed this lesion. However, in patients with a full-thickness rotator cuff tear, the biceps tendon could be demonstrated more readily with iopamidol, which is a non-ionic contrast medium.     

Schulterimpingement

The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention.     

Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?

Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.     

Arthrography of the biceps tendon

The purpose of this study was to analyse the factors having an influence on the arthrographic imaging of the biceps tendon. The study comprised 174 patients suffering from chronic shoulder pain. They underwent conventional shoulder arthrography with sodium meglumine metrizoate or metrizamide as a contrast medium. In the patients with a full-thickness tear of the rotator cuff, the biceps tendon sheath failed to fill with contrast medium more often than in those with an intact tendinous cuff. Metrizamide filled the biceps tendon sheath more readily than sodium meglumine metrizoate in patients with a full-thickness tear of the rotator cuff. The volume of the contrast medium injected had no influence on the imaging of the biceps tendon.