慢性肩關節疼痛之放射學檢查

Radiological Examinations in Patients with Chronic Shoulder Pain

從1996年1月至1998年1月，本科與放射科針對105例慢性肩關節疼痛患者，進行關節注射照相（Arthrography）檢查。結果顯示最常出現之慢性肩關節疼痛疾病包括冰凍肩（48.6%），肩轉動肌裂傷（rotator cuff tear, 20%），肩峰下骨刺合併肌肉壓迫症候群（impingement syndrome, 10.5%）及鈣化性肌腱炎（calcific periarthritis, 7.6%）。其中，19例患者（18.1%）有二種以上之病變。然而亦有21例患者（20%）未有明顯之X光或Arthrography之異常。另外，常導致肩疼痛之慢性病包括先前外傷及類風濕關節炎（簡稱RA）。本研究中，10例RA患者常出現肩關節痛成抬手無力，在10例RA患者Arthrography檢查時，4例出現rotator cuff tear，2例有冰凍肩，2例有增生性滑膜炎表現，另外2例則完全正常。使用Arthrography進行早期慢性肩關節疼痛檢查，仍不失為一有效及實用之工具，雖然近年來已逐漸被ultrasound或其他非侵襲的檢查所取代。

Objective and Methods: In order to understand the common shoulder problems, radiological examinations including x-ray and arthrography were performed in 105 patients with chronic shoulder pain from Jan. 1996 to Jan. 1998. Results: The most common problems related to shoulder pain were frozen shoulder (48.6%), rotator cuff tear (20%), subacromial spur and impingement syndrome (10.5%), and calcific tendonitis (7.6%). Nineteen patients (18.1%) had more than two disorders. However, 21 patients (20%) showed no apparent abnormalities either on conventional x-ray or arthrography. The major underlying diseases in patients with shoulder pain were previous trauma or fracture and rheumatoid arthritis (RA). In this study, RA was diagnosed in 10 patients presented with either a long-term shoulder pain or weakness during abduction. During the arthrographic examinations in RA patients, rotator cuff tear was found in four patients, frozen shoulder in two patients, proliferating hypertrophic synovium in two patients, and negative results in two patients. Conclusion: The findings in this study suggest that arthrography is still a useful and practical tool for the early recognition of frozen shoulder, rotator cuff tear, impingement syndrome and RA patients with or without shoulder complications, although it was recently replaced by ultrasound or other non-invasive examinations.