Lam King Hei Stanley, Su Daniel Chiung Jui, Wu Yung-Tsan, Fajardo Pérez Mario, Reeves Kenneth Dean, Peng Philip, Fullerton Bradley
The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong.
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Diagnostics (Basel). 2023 Aug 4;13(15):2601. doi: 10.3390/diagnostics13152601.
This report presents the first case of painful anterior shoulder snapping due to a thickened, fibrotic bursa snapping between the subscapularis and the short head of the bicep during external and internal rotation of the humerus. A 46-year-old presented with a 10-month history of on-and-off anterolateral right shoulder pain and snapping. Direct treatment to the anterior suspected lesions partially and temporarily relieved the pain but did not reduce the snapping. Further musculoskeletal examination and dynamic ultrasound scanning showed dysfunction in the scapulothoracic movement and defects of the muscles that interact with the infraspinatus aponeurotic fascia. An ultrasound-guided diagnostic injection to the suspected lesions in the infraspinatus fascia and its muscles attachments improved the scapulothoracic movement, and the snapping and pain were eliminated immediately after the injection, which further shows that the defects in the infraspinatus fascia may be the root cause of the painful anterolateral snapping. The importance of the infraspinatus fascia and its related muscle in maintaining the harmony of the scapulothoracic movement and flexibility of the shoulder is considerable.
本报告介绍了首例因肱骨内外旋时肩胛下肌与肱二头肌短头之间增厚、纤维化的滑囊发生弹响而导致肩部前方疼痛的病例。一名46岁患者有10个月间歇性右肩前外侧疼痛和弹响的病史。对疑似前部病变进行直接治疗后，疼痛部分暂时缓解，但弹响未减轻。进一步的肌肉骨骼检查和动态超声扫描显示肩胛胸壁运动功能障碍，以及与冈下肌腱膜相互作用的肌肉存在缺陷。对冈下肌筋膜及其肌肉附着处的疑似病变进行超声引导下诊断性注射后，肩胛胸壁运动得到改善，注射后弹响和疼痛立即消失，这进一步表明冈下肌筋膜的缺陷可能是肩部前外侧疼痛弹响的根本原因。冈下肌筋膜及其相关肌肉在维持肩胛胸壁运动的协调性和肩部灵活性方面具有重要意义。
