Gill Tiffany K, Shanahan E Michael, Allison Dale, Alcorn Daniel, Hill Catherine L
Discipline of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Int J Rheum Dis. 2014 Nov;17(8):863-71. doi: 10.1111/1756-185X.12476. Epub 2014 Oct 8.
The aim of this study was to determine the prevalence of structural shoulder pathology using magnetic resonance imaging (MRI) in three groups of older people: those with current shoulder pain, those with a previous history of shoulder pain and those with no history of shoulder pain, within a community-based sample.
Thirty subjects (10 within each of the three groups) participated in the study. Subjects were recruited by telephone and underwent a clinical examination of shoulder and neck range of movement (to ensure pain was not referred from the neck). Subjects completed the Shoulder Pain and Disability Index (SPADI) and underwent MRI and X-ray of the relevant shoulder. The X-rays and MRI were read independently by two experienced musculoskeletal radiologists blinded to each participant's symptoms. The MRIs were read using a structured reporting system.
The mean range of shoulder movement on both the right and left sides was lower for the current pain group compared to both the no and previous pain groups. On X-ray, there was no significant difference between groups in terms of glenohumeral and/or acromioclavicular degenerative changes. Tendinosis and tears of the rotator cuff were present in the majority of participants in each group. Labral abnormalities were rare among all groups.
Shoulder pathology is apparent in both symptomatic and asymptomatic shoulders and clinical symptoms may not match radiological findings. The cost burden of ordering MRI scans is significant and the relevance of the findings are questionable when investigating shoulder pain.
本研究旨在通过磁共振成像（MRI）确定三组老年人肩部结构病变的患病率，这三组老年人分别为：目前有肩部疼痛的人群、既往有肩部疼痛病史的人群以及无肩部疼痛病史的人群，研究样本来自社区。
30名受试者（三组各10名）参与了本研究。通过电话招募受试者，并对其肩部和颈部活动范围进行临床检查（以确保疼痛并非由颈部引起）。受试者完成肩部疼痛和功能障碍指数（SPADI）评估，并接受相关肩部的MRI和X线检查。X线和MRI由两名经验丰富的肌肉骨骼放射科医生独立阅片，阅片时他们对每位参与者的症状不知情。MRI采用结构化报告系统进行阅片。
与无疼痛组和既往疼痛组相比，目前疼痛组双侧肩部的平均活动范围更低。在X线检查中，各组间盂肱关节和/或肩锁关节的退行性改变无显著差异。每组中的大多数参与者都存在肩袖肌腱病和撕裂。所有组中盂唇异常情况均较为罕见。
有症状和无症状的肩部均存在明显的肩部病变，临床症状可能与影像学检查结果不相符。在调查肩部疼痛时，进行MRI扫描的成本负担巨大，且检查结果的相关性存疑。
