Health & Rehabilitation Research Institute, AUT University, Northcote, Auckland, New Zealand.
BMC Musculoskelet Disord. 2011 May 28;12:119. doi: 10.1186/1471-2474-12-119.
The prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB), acromioclavicular joint (ACJ) and glenohumeral joint (GHJ).
Consecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA) and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR) to diagnostic blocks.
In the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively) and MRA (65% and 76% respectively). The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR) for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p < 0.05). Ultrasound evidence of a biceps tendon sheath effusion (OR 8.0; p < 0.01) and an intact rotator cuff (OR 1.3; p < 0.05) were associated with PAR to GHJ injection. No imaging findings were strongly associated with PAR to ACJ injection (p ≤ 0.05).
Rotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.
初级保健中影像学病理的发生率受到的关注较少，而已识别的病理学与症状之间的相关性尚不清楚。本文报告了影像学病理的发生率，以及病理与对肩峰下囊（SAB）、肩锁关节（ACJ）和盂肱关节（GHJ）诊断性阻滞的反应之间的关系。
从初级保健中连续招募有肩痛的患者，进行标准的 X 射线、超声扫描和 SAB 和 ACJ 的局部麻醉诊断性注射。对这些注射中任何一种的疼痛缓解率低于 80%的患者，进行磁共振关节造影（MRA）和 GHJ 诊断性阻滞。使用 Fisher 检验评估麻醉反应组中阳性和阴性影像学发现的比例差异，并计算对诊断性阻滞的阳性麻醉反应（PAR）的优势比（OR）。
在 208 名入组患者中，超声检查显示肩袖和 SAB 的病变最常见（分别为 50%和 31%），MRA 检查结果也如此（分别为 65%和 76%）。SAB 注射后的 PAR 发生率为 34%，ACJ 注射后的 PAR 发生率为 14%。在这两种注射均报告阴性麻醉反应（NAR）的 59%患者中，有 16%对 GHJ 注射表现出 PAR。超声检查显示肩袖上旋肌全层撕裂与 SAB 注射后的 PAR 相关（OR 5.02；p < 0.05）。超声检查显示肱二头肌腱鞘积液（OR 8.0；p < 0.01）和肩袖完整（OR 1.3；p < 0.05）与 GHJ 注射后的 PAR 相关。没有影像学发现与 ACJ 注射后的 PAR 有很强的相关性（p ≤ 0.05）。
肩袖和 SAB 的病变是超声和 MRA 最常见的发现。肩袖上旋肌全层撕裂的证据与肩峰下区域的症状相关，而肱二头肌腱鞘积液和肩袖完整与关节内 GHJ 疼痛源相关。当结合临床信息时，这些结果可能有助于指导初级保健中的诊断决策。
