Henrie Tanner R, Skedros John G
Tulane University School of Medicine, New Orleans, LA, USA.
The University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT, USA.
Case Rep Radiol. 2018 Jun 10;2018:3579527. doi: 10.1155/2018/3579527. eCollection 2018.
Sarcoidosis is an idiopathic systemic inflammatory disorder characterized histologically by noncaseating granulomas. The pathogenesis likely includes genetic, immunologic, and environmental factors. The lungs, skin, and eyes are most commonly affected. Although bone involvement is possible, sarcoidosis of the humerus is rare, with few cases reported. Furthermore, we are unaware of any reports of sarcoidosis of the upper humerus with a coexisting rotator cuff tear. We report the case of a 50-year-old female with sarcoidosis of the humerus and a coexisting tear of the supraspinatus tendon. Her medical history includes type 2 diabetes, depression, and fatigue. She had chronic shoulder pain that worsened after her dog jerked on the leash. Radiographs were grossly normal. Subsequent magnetic resonance imaging (MRI) demonstrated a possible small full-thickness rotator cuff tear. Multiple rounded lesions were also noted within the proximal humerus. A biopsy demonstrated noncaseating granulomas, confirming the diagnosis of sarcoidosis. There was concern that her sarcoid lesions would compromise bone quality, limiting options for surgical repair of her rotator cuff tear. However, it was determined that her lesion did not involve cortical bone, and surgery was performed. During surgery, the supraspinatus tendon was found to be partially torn and was treated with arthroscopic debridement and acromioplasty. An excellent result was ultimately achieved after her rheumatologist started adalimumab injections. This case demonstrates that there can be a rare incidental finding of osseous sarcoid lesions in the upper humerus where the bone might be compromised in the location of a planned rotator cuff repair.
结节病是一种特发性全身性炎症性疾病，组织学特征为非干酪样肉芽肿。其发病机制可能包括遗传、免疫和环境因素。肺、皮肤和眼睛最常受累。虽然骨骼也可能受累，但肱骨结节病很少见，报道的病例很少。此外，我们尚未发现有关于肱骨上段结节病合并肩袖撕裂的报道。我们报告一例50岁女性，患有肱骨结节病并伴有冈上肌腱撕裂。她的病史包括2型糖尿病、抑郁症和疲劳。她有慢性肩部疼痛，在她的狗猛拉牵引绳后疼痛加剧。X线片大致正常。随后的磁共振成像（MRI）显示可能存在小的全层肩袖撕裂。在肱骨近端还发现了多个圆形病变。活检显示非干酪样肉芽肿，确诊为结节病。有人担心她的结节病病变会影响骨质，限制肩袖撕裂手术修复的选择。然而，经确定她的病变未累及皮质骨，于是进行了手术。手术中发现冈上肌腱部分撕裂，采用关节镜清创和肩峰成形术治疗。在她的风湿病学家开始注射阿达木单抗后，最终取得了良好的效果。该病例表明，在肱骨上段可能罕见地偶然发现骨结节病病变，而在计划进行肩袖修复的部位，骨骼可能会受到影响。
