Roberts Craig S, Davila Jeffrey N, Hushek Stephen G, Tillett Edward D, Corrigan Theresa M
Department of Orthopaedic Surgery, University of Louisville, School of Medicine, Louisville, KY 40292, USA.
J Shoulder Elbow Surg. 2002 Nov-Dec;11(6):595-9. doi: 10.1067/mse.2002.127095.
External shoulder impingement is commonly diagnosed by passively moving the shoulder into various positions of elevation and internal rotation in order to perform impingement sign maneuvers. There is a lack of agreement among clinicians regarding the positions of the anatomic structures in the subacromial space when these maneuvers are performed. The purpose of this study was to use magnetic resonance imaging to identify and measure the changes in anatomic structures in the subacromial space as the arm was moved from complete rest to 160 degrees of forward flexion during the Neer and Hawkins impingement sign maneuvers. Ten subjects with normal shoulders (mean age, 32 years) were studied. The acromiohumeral interval was smallest with the arm at the side (mean, 6.4 mm) and progressively increased as the arm was elevated from 90 degrees to 160 degrees (mean, 7.7-14.2 mm). In no instance was the rotator cuff found to be in contact with the anterior acromion. The rotator cuff insertion appeared to be in closest proximity to the anteroinferior acromion, not at full elevation (Neer sign position), but at 90 degrees of flexion (Hawkins sign position). Our data suggest that a clinically positive Hawkins sign is consistent with external shoulder impingement. Clinical suspicion that mechanisms other than impingement may be involved, particularly if the Neer impingement sign is also positive, is nonetheless advised.
外部肩部撞击症通常通过被动地将肩部移动到不同的抬高和内旋位置来进行撞击征动作检查以作出诊断。在进行这些动作时，临床医生对于肩峰下间隙内解剖结构的位置并未达成一致意见。本研究的目的是利用磁共振成像来识别和测量在进行Neer和Hawkins撞击征动作时，当手臂从完全休息位移动到前屈160度过程中肩峰下间隙内解剖结构的变化。对10名肩部正常的受试者（平均年龄32岁）进行了研究。肩峰下间隙在手臂位于身体一侧时最小（平均6.4毫米），随着手臂从90度抬高到160度，该间隙逐渐增大（平均7.7 - 14.2毫米）。在任何情况下，均未发现肩袖与肩峰前部接触。肩袖附着点似乎最靠近肩峰前下部，并非在完全抬高时（Neer征位置），而是在90度屈曲时（Hawkins征位置）。我们的数据表明，临床上阳性的Hawkins征与外部肩部撞击症相符。然而，如果Neer撞击征也为阳性，仍建议临床怀疑可能涉及除撞击之外的其他机制。
