Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres. CHU de Grenoble-Alpes, Hôpital Sud, avenue de Kimberley, BP 338, 38434 Échirolles cedex, France.
Service de Chirurgie de l'Arthrose et du Sport, Urgences Traumatiques des Membres. CHU de Grenoble-Alpes, Hôpital Sud, avenue de Kimberley, BP 338, 38434 Échirolles cedex, France.
Orthop Traumatol Surg Res. 2021 Sep;107(5):102965. doi: 10.1016/j.otsr.2021.102965. Epub 2021 May 24.
Shoulder trauma with normal radiographs is a frequent emergency presentation. The predominance of pain makes clinical examination unreliable, and complementary imaging is often needed for diagnosis. The aim of the present study was to assess the contribution of ultrasonography (US) and magnetic resonance imaging (MRI) in deciphering such trauma. The study hypothesis was that MRI can confirm most diagnoses and reveal occult lesions.
48 patients with a median age of 33 years (IQR, 22-48.75), admitted to the Emergency Department between February and September 2016, were prospectively included. All had normal X-ray and underwent emergency and deferred emergency (D+7-10) clinical examination, and US and MRI at D+7-14. The same examinations were repeated to establish diagnosis and initiate treatment. MRI was considered as gold-standard for definite diagnosis.
Diagnoses comprised: 14 shoulder contusions; 13 rotator cuff tears; 8 acromioclavicular sprains; 6 fractures: 3 greater tuberosity, 2 humeral head, 1 lateral quarter of the clavicle; 3 subluxations or anterior dislocations with spontaneous reduction; 1 posterior dislocation with spontaneous reduction; 1 case of resorption of calcification in the pectoralis major tendon; 1 case of coracobrachialis strain; and 1 partial pectoralis major detachment. Concordance with final diagnosis was 42% (20/48) on initial clinical examination and 52% (25/48) on reassessment. On US, concordance was 71% (34/48), with 82% positive predictive value for cuff tear and 0% for instability. MRI was contributive in all cases, revealing 48 abnormal signals in 41 patients, thus establishing 48 diagnoses.
Except in precise diagnostic situations such as rotator cuff tear, US is not a contributive examination, completely overlooking shoulder instability and bone contusion. MRI should play an increasing role in deciphering these traumas.
II; prospective cohort study.
伴有正常 X 线的肩部创伤是一种常见的急诊表现。疼痛的主导作用使临床检查不可靠，通常需要补充影像学检查来明确诊断。本研究旨在评估超声（US）和磁共振成像（MRI）在解读此类创伤中的作用。研究假设是 MRI 可以确认大多数诊断并发现隐匿性病变。
2016 年 2 月至 9 月期间，前瞻性纳入 48 例中位年龄为 33 岁（IQR，22-48.75）的因肩部创伤就诊于急诊科的患者。所有患者 X 线均正常，接受了急诊和延迟（D+7-10）临床检查以及 D+7-14 时的 US 和 MRI。进行相同的检查以确定诊断并开始治疗。将 MRI 作为明确诊断的金标准。
诊断包括：14 例肩部挫伤；13 例肩袖撕裂；8 例肩锁关节扭伤；6 例骨折：3 例大结节，2 例肱骨头，1 例锁骨外侧 1/4 段；3 例自发性复位的半脱位或前脱位；1 例自发性复位的后脱位；1 例胸大肌肌腱钙化吸收；1 例喙肱肌拉伤；1 例部分胸大肌撕裂。初始临床检查的符合率为 42%（20/48），再次评估的符合率为 52%（25/48）。US 的符合率为 71%（48/48），对肩袖撕裂具有 82%的阳性预测值，对不稳定具有 0%的阳性预测值。MRI 在所有病例中均有作用，在 41 例患者中发现 48 个异常信号，从而确立了 48 个诊断。
除肩袖撕裂等特定诊断情况外，US 不是一种有帮助的检查，完全忽略了肩不稳定和骨挫伤。MRI 应在解读这些创伤中发挥越来越大的作用。
II；前瞻性队列研究。
