Alfredson Håkan, Harstad Herlof, Haugen Simen, Ohberg Lars
Department of Surgical and Perioperative Science, Sports Medicine Unit, University of Umeå, 901 87 Umea, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2006 Dec;14(12):1321-6. doi: 10.1007/s00167-006-0205-8. Epub 2006 Oct 7.
The histological changes found in the supraspinatus tendon have similarities with the findings in Achilles-, patellar- and extensor carpi radialis brevis (ECRB)-tendinopathy. In recent studies, we have found a vasculo-neural ingrowth in chronic painful Achilles and patellar tendinopathy, and demonstrated good short-term clinical effects with injections of the sclerosing substance polidocanol. In this collaborative two-centre pilot study, 15 patients (10 males and 5 females, mean age 46 years) with a long duration of shoulder pain (mean 28 months), and given the diagnosis chronic painful shoulder impingement syndrome, were included. They had tried rest, traditional rehabilitation exercises and multiple subacromial corticosteroid injections, without effect. We found vascularity (neovessels) in chronic painful, but not in pain-free, supraspinatus tendons, and prospectively studied the clinical effects of ultrasound (US) and colour Doppler (CD)-guided injections of polidocanol, targeting the area with neovessels. The patients evaluated the amount of shoulder pain during horizontal shoulder activity on a visual analogue scale (VAS), and satisfaction with treatment. Two (median) (range 1-5) polidocanol treatments (with 4-8 weeks in between) were given. In four patients (considered treatment failure), cortisone was injected into an inflamed subacromial bursa at one separate occasion weeks after the last polidocanol injection. At follow-up, 8 (median) (range 4-17) months after the treatment, 14 patients were satisfied with the result. Using the visual analogue scale evaluation (VAS), the pain dropped from 79 before treatment to 21 at follow-up (P < 0.05). In the short-term perspective, sclerosing polidocanol injections targeting the neovessels in the supraspinatus tendon and/or bursa wall seems to have a potential to reduce the pain during shoulder loading activity.
在冈上肌腱中发现的组织学变化与跟腱、髌腱和桡侧腕短伸肌（ECRB）肌腱病的发现相似。在最近的研究中，我们在慢性疼痛性跟腱和髌腱病中发现了血管神经长入，并证明注射硬化剂聚多卡醇具有良好的短期临床效果。在这项双中心合作的前瞻性研究中，纳入了15例患者（10例男性和5例女性，平均年龄46岁），这些患者肩部疼痛持续时间长（平均28个月），被诊断为慢性疼痛性肩部撞击综合征。他们尝试过休息、传统康复锻炼和多次肩峰下皮质类固醇注射，但均无效。我们在慢性疼痛的冈上肌腱中发现了血管形成（新生血管），而在无痛的冈上肌腱中未发现，并且前瞻性地研究了超声（US）和彩色多普勒（CD）引导下向有新生血管区域注射聚多卡醇的临床效果。患者通过视觉模拟量表（VAS）评估水平肩部活动期间的肩部疼痛程度以及对治疗的满意度。给予两次（中位数）（范围1 - 5次）聚多卡醇治疗（间隔4 - 8周）。在4例患者（被视为治疗失败）中，在最后一次聚多卡醇注射数周后的一个单独时间，将皮质醇注射到发炎的肩峰下滑囊中。在治疗后8个月（中位数）（范围4 - 17个月）的随访中，14例患者对结果满意。使用视觉模拟量表评估（VAS），疼痛程度从治疗前的79降至随访时的21（P < 0.05）。从短期来看，针对冈上肌腱和/或滑囊壁新生血管注射硬化剂聚多卡醇似乎有可能减轻肩部负重活动期间的疼痛。
