Lu Michael T, Abboud Joseph A
Department of Orthopedic Surgery, University of Pennsylvania, 800 Spruce St, First Floor, Cathcart Building, Philadelphia, PA 19107, USA.
Orthopedics. 2011 Sep 9;34(9):e581-3. doi: 10.3928/01477447-20110714-19.
The most common cause of impingement syndrome is mechanical irritation of the subacromial bursa and rotator cuff by the coracoacromial arch. Offending structures include the undersurface of the anterolateral acromion, coracoacromial ligament, and the undersurface of the distal clavicle. We present a case of impingement syndrome caused by mechanical irritation of the rotator cuff by a subacromial osteochondroma that was successfully treated with arthroscopic resection. Osteochondroma is the second most common benign bone tumor following nonossifying fibroma. These lesions are thought to arise from aberrant growth of normal epiphyseal growth plate cartilage. Ninety percent of osteochondromas arise from the metaphyseal regions of long bones (eg, distal femur, proximal tibia, or proximal humerus). Scapular involvement accounts for 3.0% to 4.6% of all reported osteochondromas. These lesions represent 14.4% of all tumors of the scapula and 49% of benign scapular tumors, making them the most common benign bone tumors of the scapula. Our patient failed nonoperative management of his subacromial osteochondroma. The concern for malignant transformation was low, as the patient's pain had been consistent for the past 15 years. Although his pain had been largely unchanged for more than a decade, he elected to undergo resection so that he could resume the hobbies that his pain had forced him to abandon. He reported substantial pain relief and restoration of function following arthroscopic resection and subacromial decompression, reinforcing mechanical irritation of the rotator cuff as the source of his shoulder pain and dysfunction. To our knowledge, this is the first report of arthroscopic resection of a subacromial osteochondroma.
撞击综合征最常见的病因是喙肩弓对肩峰下滑囊和肩袖的机械性刺激。致病结构包括肩峰前外侧的下表面、喙肩韧带和锁骨远端的下表面。我们报告一例肩峰下骨软骨瘤对肩袖造成机械性刺激引起的撞击综合征病例，该病例经关节镜切除成功治愈。骨软骨瘤是继非骨化性纤维瘤之后第二常见的良性骨肿瘤。这些病变被认为源于正常骨骺生长板软骨的异常生长。90%的骨软骨瘤起源于长骨的干骺端区域（如股骨远端、胫骨近端或肱骨近端）。肩胛骨受累占所有报告的骨软骨瘤的3.0%至4.6%。这些病变占肩胛骨所有肿瘤的14.4%，占肩胛骨良性肿瘤的49%，使其成为肩胛骨最常见的良性骨肿瘤。我们的患者肩峰下骨软骨瘤的非手术治疗失败。由于患者的疼痛在过去15年一直持续，因此恶性转化的担忧较低。尽管他的疼痛在十多年里基本没有变化，但他选择接受切除手术，以便能够重新开始因疼痛而被迫放弃的爱好。他报告说，关节镜切除和肩峰下减压后疼痛明显缓解，功能恢复，这进一步证明了肩袖的机械性刺激是其肩部疼痛和功能障碍的根源。据我们所知，这是肩峰下骨软骨瘤关节镜切除的首例报告。
