Robinson Dror, Halperin Nahum, Agar Gabriel, Alk Doron, Rami Kardosh
Department of Othopedics, Assaf Harofe Medical Center, Zeriffin, Israel.
J Shoulder Elbow Surg. 2003 Sep-Oct;12(5):451-5. doi: 10.1016/s1058-2746(03)00092-2.
Shoulder pain and immobility comprise a multifactorial disorder apparently affected by pain inhibiting joint motion. As the syndrome is very common, many patients do not undergo detailed imaging studies before treatment. This study compared a series of 7 patients in whom a neoplasm was the underlying cause for the stiff shoulder with a series of 50 patients with primary or secondary frozen shoulder. In addition to a detailed history being taken, the Disabilities of the Arm, Shoulder, and Hand (DASH) upper limb outcomes data collection questionnaire was completed and physical examination, radiography, ultrasonography, and bone scanning were performed in all cases. In the cases of tumor, the presenting symptom was a stiff shoulder without radiographic abnormality in 7 of 67 patients with shoulder girdle neoplasms who were seen at our musculoskeletal oncology clinic. The tumors included osteoid osteoma, osteoblastoma, metastatic carcinoma, chondrosarcoma, periosteal lipoma, and acute lymphoblastic lymphoma. The diagnosis was established in all cases by an area of focal isotope uptake demonstrated by a routine technetium 99 methylene diphosphonate bone scan. In a single case of metastatic colon carcinoma, the diagnosis could only be established by magnetic resonance imaging, as the radiographs were normal and the bone scan demonstrated diffuse uptake over the proximal humerus. The patients whose frozen shoulder was caused by an underlying tumor were significantly younger and had a lower fatigue/energy dimension score on the RAND Short Form-36 health survey. The most useful diagnostic test appears to be a discrete area of bony tenderness, present in 7 of 7 patients with tumor and in only 5 of 50 patients in the control group. Although an underlying tumor is a rare cause of frozen shoulder syndrome, the potential grave consequences of misdiagnosis and the possibility of performing an unnecessary and ineffective invasive procedure should prompt physicians to increased vigilance. In patients with discrete bony tenderness elicited by light tapping, a bone scan should be ordered and magnetic resonance imaging should be considered.
肩部疼痛和活动受限是一种多因素紊乱疾病，显然受疼痛抑制关节活动的影响。由于该综合征非常常见，许多患者在治疗前未接受详细的影像学检查。本研究将7例以肿瘤为肩部僵硬潜在病因的患者与50例原发性或继发性肩周炎患者进行了比较。除了详细询问病史外，所有病例均完成了上肢功能障碍（DASH）结局数据收集问卷，并进行了体格检查、放射照相、超声检查和骨扫描。在肿瘤病例中，在我们肌肉骨骼肿瘤诊所就诊的67例肩胛带肿瘤患者中，有7例的主要症状是肩部僵硬且放射照相无异常。这些肿瘤包括骨样骨瘤、骨母细胞瘤、转移癌、软骨肉瘤、骨膜脂肪瘤和急性淋巴细胞性淋巴瘤。所有病例均通过常规锝99亚甲基二膦酸盐骨扫描显示的局灶性同位素摄取区域确诊。在1例转移性结肠癌病例中，由于放射照相正常且骨扫描显示肱骨近端弥漫性摄取，只能通过磁共振成像确诊。由潜在肿瘤引起肩周炎的患者明显更年轻，在兰德36项简短健康调查中的疲劳/精力维度得分更低。最有用的诊断检查似乎是局限性骨压痛区域，7例肿瘤患者中有7例出现，而对照组50例患者中只有5例出现。虽然潜在肿瘤是肩周炎综合征的罕见病因，但误诊的潜在严重后果以及进行不必要且无效的侵入性手术的可能性应促使医生提高警惕。对于轻叩引起局限性骨压痛的患者，应进行骨扫描并考虑磁共振成像检查。
