Orthopaedic Registrar, Middlemore Hospital Orthopaedic Department, Counties Manukau District Health Board, Auckland, New Zealand.
Orthopaedic Consultant, Christchurch Hospital Orthopaedic Department, Canterbury District Health Board, Christchurch, Auckland.
N Z Med J. 2024 Mar 22;137(1592):77-89. doi: 10.26635/6965.6408.
We reviewed the last decade of literature to update a previous publication on this topic by the senior author. In New Zealand, traumatic causation has implications for entitlement for treatment though the Accident Compensation Corporation (ACC). Acuity and chronicity may also be relevant in determining repairability.
Literature was reviewed regarding acromial morphology, greater tuberosity (GT) cysts, acromiohumeral interval (AHI), fatty degeneration and atrophy, acromioclavicular (AC) arthrosis, tendinopathy, bursal changes and other features.
Some factors can be considered normal for those middle aged and older, including AC arthrosis, type 1 and 2 acromion and tendinopathy. Some factors may indicate acuity, including haemorrhage and debris, GT oedema, mid-substance soft tissue tear, kinking of the tendon and isolated complete subscapularis tears. Other factors may be associated with chronicity, including significant fatty degeneration, positive tangent sign for atrophy, anterior GT cysts, type 3 acromion, critical shoulder angle (CSA) >35 degrees and acromial index (AI) <0.7.
A multitude of factors on imaging may infer, to a varying degree, the likelihood of acuity or chronicity. The patient history is also of importance in determining causation.
我们回顾了过去十年的文献，以更新该主题资深作者之前的一篇出版物。在新西兰，创伤的原因对是否有资格通过意外赔偿公司（ACC）接受治疗有影响。严重程度和慢性程度也可能与修复的可能性有关。
对肩峰形态、大结节（GT）囊肿、肩肱间隙（AHI）、脂肪变性和萎缩、肩锁关节炎、肌腱病、滑囊炎变化和其他特征的文献进行了回顾。
对于中年及以上人群，一些因素可以被认为是正常的，包括肩锁关节炎、1 型和 2 型肩峰和肌腱病。一些因素可能表明损伤的急性程度，包括出血和碎片、GT 水肿、实质中部软组织撕裂、肌腱扭曲和孤立的完全肩胛下肌撕裂。其他因素可能与慢性程度有关，包括明显的脂肪变性、萎缩的正切征、前 GT 囊肿、3 型肩峰、临界肩角（CSA）>35 度和肩峰指数（AI）<0.7。
影像学上的多种因素在不同程度上可以推断出损伤的急性或慢性程度。患者的病史对确定病因也很重要。
