Wilke A, Wolf U, Lageard P, Griss P
Orthopädische Universitätsklinik Marburg, Germany.
Man Ther. 2000 Aug;5(3):181-4. doi: 10.1054/math.2000.0364.
An unusual case of lower thoracic disc herniation combined with shoulder pain is presented in this case report, A literature search showed that shoulder pain associated with a lower thoracic disc herniation has not yet been reported. An acromioplasty for chronic impingement syndrome was performed to relieve the patient's shoulder symptoms. An unsatisfactory outcome plus a progressive but incomplete paraplegia, prompted further investigation and this revealed a low thoracic herniation. The nucleotomy which followed afterwards lead to a rapid improvement of both the shoulder symptoms and the incomplete paraplegia. This case report shows that chronic shoulder pain may be caused or exacerbated by a thoracic disc herniation in the low thoracic spine. Therefore, prior to performing surgery for peripheral joint symptomatology, the possibility of a central sensitising trigger should be excluded by physical examination of neural tissue dynamics as well as any other necessary confirmatory investigations.
本病例报告展示了一例罕见的下胸椎间盘突出合并肩部疼痛的病例。文献检索显示，尚未有下胸椎间盘突出相关肩部疼痛的报道。为缓解患者的肩部症状，实施了慢性撞击综合征肩峰成形术。结果不尽人意，且出现进行性但不完全性截瘫，促使进一步检查，结果发现下胸段椎间盘突出。随后进行的髓核摘除术使肩部症状和不完全性截瘫迅速改善。本病例报告表明，下胸段脊柱的胸椎间盘突出可能导致或加重慢性肩部疼痛。因此，在对外周关节症状进行手术之前，应通过神经组织动力学体格检查以及任何其他必要的确诊检查，排除中枢敏化触发因素的可能性。
