The Steadman Clinic, Vail, Colorado 81657, USA.
Arthroscopy. 2011 Apr;27(4):556-67. doi: 10.1016/j.arthro.2010.10.004. Epub 2011 Feb 4.
The rotator interval describes the anatomic space bounded by the subscapularis, supraspinatus, and coracoid. This space contains the coracohumeral and superior glenohumeral ligament, the biceps tendon, and anterior joint capsule. Although a definitive role of the rotator interval structures has not been established, it is apparent that they contribute to shoulder dysfunction. Contracture or scarring of rotator interval structures can manifest as adhesive capsulitis. It is typically managed nonsurgically with local injections and gentle shoulder therapy. Recalcitrant cases have been successfully managed with an arthroscopic interval release and manipulation. Conversely, laxity of rotator interval structures may contribute to glenohumeral instability. In some cases this can be managed with one of a number of arthroscopic interval closure techniques. Instability of the biceps tendon is often a direct result of damage to the rotator interval. Damage to the biceps pulley structures can lead to biceps tendon subluxation or dislocation depending on the structures injured. Although some authors describe reconstruction of this tissue sling, most recommend tenodesis or tenotomy if it is significantly damaged. Impingement between the coracoid and lesser humeral tuberosity is a relatively well-established, yet less common cause of anterior shoulder pain. It may also contribute to injury of the anterosuperior rotator cuff and rotator interval structures. Although radiographic indices are described, it appears intraoperative dynamic testing may be more helpful in substantiating the diagnosis. A high index of suspicion should be used in association with biceps pulley damage or anterosuperior rotator cuff tears. Coracoid impingement can be treated with either open or arthroscopic techniques. We review the anatomy and function of the rotator interval. The presentation, physical examination, imaging characteristics, and management strategies are discussed for various diagnoses attributable to the rotator interval. Our preferred methods for treatment of each lesion are also discussed.
旋转间隔描述了由肩胛下肌、冈上肌和喙突围成的解剖空间。这个空间包含了喙肱韧带和肩盂上韧带、肱二头肌肌腱和前关节囊。虽然旋转间隔结构的明确作用尚未确定，但很明显它们对肩部功能有影响。旋转间隔结构的挛缩或瘢痕形成可能表现为粘连性关节囊炎。通常采用局部注射和温和的肩部治疗来非手术治疗。对于顽固病例，关节镜下间隔松解和手法治疗可取得成功。相反，旋转间隔结构的松弛可能导致肩盂肱关节不稳定。在某些情况下，可采用多种关节镜下间隔闭合技术之一进行治疗。肱二头肌肌腱的不稳定通常是旋转间隔损伤的直接结果。肱二头肌滑车结构的损伤可导致肱二头肌肌腱半脱位或脱位，具体取决于损伤的结构。尽管一些作者描述了这种组织吊带的重建，但如果它受到严重损伤，大多数作者建议进行肌腱固定术或肌腱切断术。喙突与小肱骨结节之间的撞击是一种相对成熟但较少见的引起肩部前侧疼痛的原因。它也可能导致肩袖前上部分和旋转间隔结构的损伤。虽然描述了放射学指标，但似乎术中动态测试可能更有助于证实诊断。在存在肱二头肌滑车损伤或肩袖前上部分撕裂时，应高度怀疑有该病症。喙突撞击可采用开放式或关节镜技术治疗。我们回顾了旋转间隔的解剖结构和功能。讨论了各种归因于旋转间隔的诊断的表现、体格检查、影像学特征和治疗策略。还讨论了我们对每种病变的首选治疗方法。
