Chang Ke-Vin, Chen Wen-Shiang, Wang Tyng-Guey, Hung Chen-Yu, Chien Kuo-Liong
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, and National Taiwan University College of Medicine, Tapei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Ultrasound Med Biol. 2014 Feb;40(2):313-21. doi: 10.1016/j.ultrasmedbio.2013.10.002. Epub 2013 Dec 7.
Bicipital peritendinous effusion (BPE), a common ultrasonographic finding of the long head of the biceps tendon, may be associated with shoulder joint derangement, but supporting evidence from large-scale studies is lacking. The aim of this cross-sectional study was to determine the strength of the association between BPE and sonographic abnormalities of the shoulder joint. We reviewed the sonographic reports of patients with suspected shoulder disorders investigated ultrasonographically between January 2011 and January 2012. BPE was graded according to its measured thickness as absent (<1 mm), mild (1-2 mm), moderate (2-3 mm) or severe (>3 mm). The associations between BPE and sonographic abnormalities were examined using multinomial logistic regression adjusted for age, gender, affected side and clinical diagnosis of frozen shoulder. The prevalence rates of absent, mild, moderate and severe BPE among the 907 shoulders examined were 64.1%, 17.8%, 10.4% and 7.7%, respectively. Frozen shoulder was associated with mild BPE (relative risk [RR] vs. participants without BPE = 1.83, 95% confidence interval [CI] = 1.28-2.50). Sonographic findings of biceps tendinopathy, subdeltoid bursitis and full-thickness tears of the supraspinatus tendon were significantly associated with the entire spectrum of BPE, whereas subscapularis tendon tears were significantly associated with moderate (RR = 2.47, 95% CI = 1.29-4.69) and severe (RR = 3.11, 95% CI = 1.51-6.33) BPE. Severe BPE was associated with articular-sided partial-thickness tears of the supraspinatus tendon (RR = 14.32, 95% CI = 4.30-34.35), posterior recess effusion (RR, 7.98, 95% CI = 1.44-34.93) and biceps medial subluxation (RR = 7.25, 95% CI = 1.90-22.33). Our study indicates that BPE is related to various shoulder abnormalities and that the strengths of these associations depend on the severity of BPE. Clinicians encountering BPE should grade its severity and be alert for hidden lesions of the shoulder joint.
肱二头肌肌腱周围积液（BPE）是肱二头肌长头常见的超声检查结果，可能与肩关节紊乱有关，但缺乏大规模研究的支持证据。这项横断面研究的目的是确定BPE与肩关节超声异常之间关联的强度。我们回顾了2011年1月至2012年1月间接受超声检查的疑似肩部疾病患者的超声报告。根据测量厚度将BPE分为无（<1毫米）、轻度（1 - 2毫米）、中度（2 - 3毫米）或重度（>3毫米）。使用多因素逻辑回归分析BPE与超声异常之间的关联，并对年龄、性别、患侧和肩周炎临床诊断进行校正。在检查的907个肩部中，无、轻度、中度和重度BPE的患病率分别为64.1%、17.8%、10.4%和7.7%。肩周炎与轻度BPE相关（相对风险[RR]与无BPE参与者相比 = 1.83，95%置信区间[CI] = 1.28 - 2.50）。肱二头肌肌腱病、肩峰下滑囊炎和冈上肌腱全层撕裂的超声表现与整个BPE范围显著相关，而肩胛下肌腱撕裂与中度（RR = 2.47，95% CI = 1.29 - 4.69）和重度（RR = 3.11，95% CI = 1.51 - 6.33）BPE显著相关。重度BPE与冈上肌腱关节侧部分厚度撕裂（RR = 14.32，95% CI = 4.30 - 34.35）、后方隐窝积液（RR = 7.98，95% CI = 1.44 - 34.93）和肱二头肌内侧半脱位（RR = 7.25，95% CI = 1.90 - 22.33）相关。我们的研究表明，BPE与多种肩部异常有关，且这些关联的强度取决于BPE的严重程度。遇到BPE的临床医生应评估其严重程度，并警惕肩关节的隐匿性病变。
