Hollister M S, Mack L A, Patten R M, Winter T C, Matsen F A, Veith R R
Department of Radiology, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA.
AJR Am J Roentgenol. 1995 Sep;165(3):605-8. doi: 10.2214/ajr.165.3.7645478.
Although an association between sonographically detected joint fluid and rotator cuff disease has been reported, the significance of sonographically detected subacromial/subdeltoid bursal effusion has not been studied. We examined a group of patients who had shoulder sonography and surgery to determine the association between bursal and joint effusion and surgically proved tears of the rotator cuff.
We retrospectively reviewed the preoperative shoulder sonography reports of 163 patients for the presence of fluid within the subacromial/subdeltoid bursa or glenohumeral joint. Surgical reports were obtained to determine the status of the rotator cuff. The sonographic reports of 232 asymptomatic shoulders were also reviewed to determine the prevalence of fluid within the subacromial/subdeltoid bursa or the glenohumeral joint.
Sixty-seven (41%) of the 163 patients had a joint effusion, bursal fluid, or both. Joint effusion alone was seen in 35 patients. Fourteen of these had a normal rotator cuff at surgery, and 21 had a rotator cuff tear (sensitivity, 22%; specificity, 79%; positive predictive value, 60%). Bursal fluid alone was seen in 10 patients, seven of whom had a rotator cuff tear (sensitivity, 7%; specificity, 96%; positive predictive value, 70%). In 22 patients, fluid was seen in both the bursa and the joint; 21 had surgically proved rotator cuff tears (sensitivity, 22%; specificity, 99%; positive predictive value, 95%). Of the 232 asymptomatic shoulders, 16 (6.9%) had isolated joint effusions, eight (3.4%) had isolated bursal effusions, and four (1.7%) had both joint and bursal effusions.
The sonographic finding of intraarticular fluid alone (without bursal fluid) has both a low sensitivity and a low specificity for the diagnosis of rotator cuff tears. However, the finding of fluid in the subacromial/subdeltoid bursa, especially when combined with a joint effusion, is highly specific and has a high positive predictive value for associated rotator cuff tears. Sonographically detected fluid in both the joint and the bursa is an uncommon finding in asymptomatic shoulders. The sonographic observation of fluid in the subacromial bursa, either isolated or combined with a joint effusion, should prompt a careful evaluation of the supraspinatus tendon for tear.
尽管已有报道超声检测到的关节积液与肩袖疾病之间存在关联，但超声检测到的肩峰下/三角肌下滑囊积液的意义尚未得到研究。我们对一组接受肩部超声检查和手术的患者进行了检查，以确定滑囊和关节积液与手术证实的肩袖撕裂之间的关联。
我们回顾性分析了163例患者术前肩部超声检查报告，以确定肩峰下/三角肌下滑囊或盂肱关节内是否存在积液。获取手术报告以确定肩袖的状况。我们还回顾了232例无症状肩部的超声检查报告，以确定肩峰下/三角肌下滑囊或盂肱关节内积液的发生率。
163例患者中有67例（41%）存在关节积液、滑囊积液或两者皆有。仅有关节积液的患者有35例。其中14例手术时肩袖正常，21例存在肩袖撕裂（敏感性为22%；特异性为79%；阳性预测值为60%）。仅滑囊积液的患者有10例，其中7例存在肩袖撕裂（敏感性为7%；特异性为96%；阳性预测值为70%）。22例患者滑囊和关节均有积液；21例经手术证实存在肩袖撕裂（敏感性为22%；特异性为99%；阳性预测值为95%）。在232例无症状肩部中，16例（6.9%）有孤立的关节积液，8例（3.4%）有孤立的滑囊积液，4例（1.7%）关节和滑囊均有积液。
仅关节内积液（无滑囊积液）的超声表现对肩袖撕裂的诊断敏感性和特异性均较低。然而，肩峰下/三角肌下滑囊内有积液的表现，尤其是合并关节积液时，对相关肩袖撕裂具有高度特异性和较高的阳性预测值。关节和滑囊均有超声检测到的积液在无症状肩部中并不常见。肩峰下滑囊内有积液的超声表现（无论是孤立的还是合并关节积液），都应促使对冈上肌腱进行仔细评估以确定是否存在撕裂。
