冰凍肩的超音波檢查

LItrasound Examination of Frozen Shoulder

冰凍肩是引起慢性肩痛及失能的常見原因，其診斷有賴於詳細的病史與理學檢查，並佐以影像學檢查。軟組織超音波不具侵入性，方便簡單又可做動態檢查，加上近年來其解像力不斷提高，適合於做冰凍肩之篩檢。本研究利用10MHz高解像力之超音波，檢查了51名患者共56個肩膀。檢查內容包括患者的肱二頭肌、脊上肌、脊下肌、滑液囊及肱骨頭之活動，參考Mack等人及Crass等人的檢查步驟。結果顯示有43%（24個）之患者有滑液囊發炎、腫脹現象，16%（9個）患者有肱二頭肌長頭肌腱炎，43%（24個）患者有脊上肌肌腱斷裂，57%（32個）患者有夾入現象。由本研究得知，冰凍肩患者常合併有滑液囊之發炎腫脹、脊上肌肌腱斷裂、及肱二頭肌長頭肌腱炎。除了常規之關節運動外，若能針對其病理變化加以治療，療效就更易顯現。所以，我們認為高解像力之超音波可作為冰凍肩診斷及治療之輔助工具，它方便簡單，適當的使用將有助於決定此類患者之治療方式。

Improvements in equipment design and examination technique have led to an increasing role for ultrasound in detecting soft tissue lesions. Ultrasound examination is noninvasive, widely available, less expensive, and allows dynamic study. Using ultrasound, we investigated the related soft tissue pathologies in individuals diagnosed as having frozen shoulder. Using a 10 MHz linear transducer probe (Diasonic® VST master series), we examined 56 shoulders in 51 patients. The images consisted of transverse and longitudinal views of the biceps, supraspinatus, infraspinatus and subacromio-subdeltoid bursa, and dynamic motion of the humeral head. Sonography demostrated either subacromio-subdeltoid bursitis or bursa dilatation in 43% of patients, biceps tendinitis in 16%, and partial rupture of the supraspinatus in 43%. Moreover impingement was found in 57% of patients. We conclude that individuals with frozen shoulder have various surrounding soft tissuc disorders. Ultrasound is a reliable and useful diagnostic tool to detect these pathologies. Based on the different pathologies detected by ultrasound, more specific and effective therapeutic policy can be instituted.