Seeger L L, Gold R H, Bassett L W, Ellman H
Department of Radiological Sciences, University of California at Los Angeles School of Medicine 90024.
AJR Am J Roentgenol. 1988 Feb;150(2):343-7. doi: 10.2214/ajr.150.2.343.
The shoulder impingement syndrome refers to a condition in which the supraspinatus tendon and subacromial bursa are chronically entrapped between the humeral head inferiorly and either the anterior acromion itself, spurs of the anterior acromion or acromioclavicular joint, or the coracoacromial ligament superiorly. As a result, the space for the bursa and tendon is reduced, and repeated trauma to these structures leads to bursitis and rotator cuff injury. Although pain and limitation of motion are common early findings, the diagnosis is often delayed until a complete tear of the rotator cuff has occurred. In an attempt to determine if MR can be used to depict the abnormalities associated with impingement syndrome (subacromial bursitis, supraspinatus tendinitis, and rotator cuff tear), we reviewed 107 MR scans of painful shoulders. Changes consistent with impingement syndrome were found in 53 patients (50%), 32 of whom underwent subsequent arthrography or surgery. MR was found capable of depicting several soft-tissue and bony abnormalities that have been clinically described in impingement syndrome. In regions of inflammation, we found that the supraspinatus tendon and/or the subacromial bursa were compressed by spurs (25 shoulders), capsular hypertrophy of the acromioclavicular joint (six shoulders), and/or low-lying acromion (14 shoulders). While T1-weighted MR imaging was highly sensitive to abnormalities of the supraspinatus tendon, tendinitis could be differentiated from a small tear of the supraspinatus tendon only with T2-weighted imaging. Large, full-thickness tears, especially if chronic, produced characteristic MR findings on both T1- and T2-weighted images. We conclude that MR can be used to detect several abnormalities associated with the shoulder impingement syndrome.
肩部撞击综合征是指一种状况，即冈上肌腱和肩峰下囊长期被困于下方的肱骨头与上方的肩峰前部本身、肩峰前部的骨刺或肩锁关节，或喙肩韧带之间。结果，滑囊和肌腱的空间减小，这些结构反复受到创伤会导致滑囊炎和肩袖损伤。虽然疼痛和活动受限是早期常见的表现，但诊断往往会延迟，直到肩袖完全撕裂才得以确诊。为了确定磁共振成像（MR）是否可用于描绘与撞击综合征相关的异常情况（肩峰下滑囊炎、冈上肌腱炎和肩袖撕裂），我们回顾了107例肩部疼痛患者的MR扫描图像。53例患者（50%）发现了与撞击综合征相符的变化，其中32例随后接受了关节造影或手术。结果发现，MR能够描绘出撞击综合征临床描述中的几种软组织和骨骼异常情况。在炎症区域，我们发现冈上肌腱和/或肩峰下滑囊受到骨刺压迫（25例肩部）、肩锁关节囊肥厚（6例肩部）和/或低位肩峰（14例肩部）。虽然T1加权MR成像对冈上肌腱异常高度敏感，但肌腱炎只有通过T2加权成像才能与冈上肌腱小撕裂相鉴别。大的、全层撕裂，尤其是慢性撕裂，在T1加权和T2加权图像上都会产生特征性的MR表现。我们得出结论，MR可用于检测与肩部撞击综合征相关的几种异常情况。
