Menachem A, Kaplan O, Dekel S
Orthopaedic B Department, Ichilov Hospital, Sourasky Medical Center, Tel Aviv.
Bull Hosp Jt Dis. 1993 Spring;53(1):21-4.
Twenty-two patients, all young females, presenting with a common clinical picture of pain over the upper medial angle of the scapula were studied. The dominant shoulder was the most commonly involved (82%). Pain radiated to the neck and shoulder, but rarely to the arm. Movements that stretched the levator scapulae on the affected side aggravated symptoms. Radiographs and bone scans of the shoulders and cervical spine were negative. Increased heat emission from the upper medial angle of the affected shoulder was found on thermography in more than 60% of the patients. Anatomic dissections of 30 cadaveric shoulders showed great variability in the insertion of the levator. A bursa was found between the scapula, the serratus, and the levator in more than 50% of the shoulders. This study suggests that this syndrome, leading to bursitis and pain, may be caused by anatomic variations of the insertion of the levator scapulae and origin of the serratus anterior. This may explain the constant trigger point and crepitation as well as the increased heat emission found on thermography. Local steroid injections relieved symptoms partially in 75% of those patients who underwent treatment.
对22例患者进行了研究，这些患者均为年轻女性，表现出肩胛上角疼痛的常见临床症状。优势肩是最常受累的部位（82%）。疼痛放射至颈部和肩部，但很少放射至手臂。拉伸患侧肩胛提肌的动作会加重症状。肩部和颈椎的X线片及骨扫描结果均为阴性。超过60%的患者在热成像检查中发现患侧肩胛上角的热辐射增加。对30个尸体肩部进行的解剖显示，肩胛提肌的附着点存在很大差异。超过50%的肩部在肩胛骨、前锯肌和肩胛提肌之间发现了一个滑囊。本研究表明，这种导致滑囊炎和疼痛的综合征可能是由肩胛提肌附着点和前锯肌起点的解剖变异引起的。这可能解释了持续存在的触发点和摩擦音，以及热成像检查中发现的热辐射增加。局部注射类固醇使75%接受治疗的患者症状部分缓解。
