Burns W C, Whipple T L
Orthopaedic Research of Virginia, Richmond.
Clin Orthop Relat Res. 1993 Sep(294):96-102.
Impingement syndrome of the shoulder may be produced by compression of the subacromial structures against the coracoacromial arch. The anterior tip of the acromion, the coracoacromial ligament, and the coracoid process have been implicated as sources of impingement. Anatomic specimens were examined to determine the anatomic sites on the coracoacromial arch that result in compression of the subacromial structures during specific shoulder motions that are known to produce impingement pain. The relationships of the supraspinatus tendon, the biceps tendon, and the greater tuberosity of the humerus with the coracoacromial arch were demonstrated through various arcs of shoulder motion in autopsy subjects. Biceps tendon impingement occurred predominantly against the lateral free edge of the coracoacromial ligament. Impingement of the supraspinatus tendon and greater tuberosity was demonstrated primarily against the acromial end of the coracoacromial ligament and the anterior tip of the acromion during arcs of flexion and internal rotation. The coracoacromial ligament was stretched by the greater tuberosity passing beneath it. This may explain the formation of traction osteophytes on the anterior acromion in patients with chronic impingement symptoms.
肩部撞击综合征可能是由于肩峰下结构受到喙肩弓的压迫所致。肩峰前缘、喙肩韧带和喙突被认为是撞击的来源。对解剖标本进行检查，以确定喙肩弓上在已知会产生撞击疼痛的特定肩部运动过程中导致肩峰下结构受压的解剖部位。通过尸检对象肩部运动的不同弧度，展示了冈上肌腱、肱二头肌肌腱和肱骨大结节与喙肩弓的关系。肱二头肌肌腱撞击主要发生在喙肩韧带的外侧游离缘。在屈曲和内旋弧度过程中，冈上肌腱和大结节的撞击主要表现为对喙肩韧带的肩峰端和肩峰前缘。大结节从喙肩韧带下方经过时会拉伸该韧带。这可能解释了慢性撞击症状患者肩峰前缘牵引性骨赘的形成。
