Dierckman Brian D, Shah Nirav R, Larose Connor R, Gerbrandt Stacey, Getelman Mark H
Southern California Orthopedic Institute, CA 91405, USA.
Int J Shoulder Surg. 2013 Jul;7(3):83-90. doi: 10.4103/0973-6042.118876.
(1) Describe a previously unreported finding involving the intra-articular portion of the subscapularis, the Conrad lesion. (2) Describe a novel classification system for the spectrum of non-insertional tendinopathy of the subscapularis. (3) Report the outcomes of surgical treatment of this spectrum of pathology.
Outcomes of 34 patients (23 males and 11 females, mean age 60.5 ± 7.5) with non-insertional tendinopathy of the subscapularis treated arthroscopically were retrospectively reviewed. All patients had anterior shoulder pain with no weakness during belly-press testing and no subscapularis footprint involvement on magnetic resonance imaging. All patients were managed with subscapularis tendon debridement and side-to-side repair along with treatment of concomitant pathology.
Seven patients had a Type I lesion (so-called Conrad lesion) - a nodule on the leading edge of the subscapularis. Eighteen patients had a Type II lesion - a visible split tear with degeneration in the upper ½ of the intra-articular tendon. Nine patients had a Type III lesion - more extensive splitting in the tendon with advanced tendon degeneration. At a mean follow-up of 24 months, 97% of patients were completely satisfied. Significant improvements were seen in forward elevation (152 ± 12° to 172 ± 5°, P < 0.001) and visual analog scale pain scores (5.9 ± 1.7-0.6 ± 1.0, P < 0.001). Internal rotation strength and external rotation motion at the side were maintained. ASES scores averaged 95.4 ± 7.4, disabilities of arm, shoulder and hand scores averaged 6.19 ± 9.8, Western Ontario Rotator Cuff scores averaged 91.7 ± 9.3 and the average University of California at Los Angeles score was 33.1 ± 2.4.
We present a previously unreported finding of the subscapularis, the Conrad lesion, along with a novel classification system for non-insertional tendinopathy of the subscapularis. Arthroscopic treatment of this spectrum of tendinopathy along with concomitant shoulder pathology eliminated pain and improved patient outcomes without detrimental effects.
IV, Retrospective Case Series.
（1）描述一项此前未报道的涉及肩胛下肌关节内部分的发现，即康拉德病变。（2）描述一种针对肩胛下肌非插入性肌腱病谱系的新型分类系统。（3）报告该谱系病理的手术治疗结果。
对34例经关节镜治疗的肩胛下肌非插入性肌腱病患者（23例男性，11例女性，平均年龄60.5±7.5岁）的治疗结果进行回顾性分析。所有患者均有肩部前方疼痛，在压腹试验时无肌力减弱，磁共振成像显示肩胛下肌止点未受累。所有患者均接受肩胛下肌腱清创及端端修复，并同时治疗合并的病变。
7例患者为I型病变（即所谓的康拉德病变）——肩胛下肌前缘有一个结节。18例患者为II型病变——关节内肌腱上半部分可见撕裂并伴有退变。9例患者为III型病变——肌腱有更广泛的撕裂且伴有严重的肌腱退变。平均随访24个月时，97%的患者完全满意。前屈活动度（从152±12°提高到172±5°，P<0.001）和视觉模拟评分疼痛分数（从5.9±1.7降至0.6±1.0，P<0.001）有显著改善。患侧内旋力量和外旋活动度得以维持。美国肩肘外科医师学会（ASES）评分平均为95.4±7.4，上肢、肩部和手部功能障碍（DASH）评分平均为6.19±9.8，西 Ontario 肩袖评分平均为91.7±9.3，加利福尼亚大学洛杉矶分校（UCLA）评分平均为33.1±2.4。
我们报告了一项此前未报道的肩胛下肌发现，即康拉德病变，以及一种针对肩胛下肌非插入性肌腱病的新型分类系统。关节镜治疗该谱系的肌腱病及合并的肩部病变可消除疼痛并改善患者预后，且无不良影响。
IV，回顾性病例系列研究。
