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A Retrospective Investigation of Ultrasound Findings in Patients with Shoulder Pain from One Center in Northern Taiwan

骨骼肌肉超音波於病人肩關節疼痛的診斷-北台灣一家醫學中心的病歷回溯性調查

摘要


目的:研究報告顯示在一般成人中,約有15-30%於生活過程中會經歷肩部疼痛。骨骼肌肉超音波的敏感性和特異性已獲得證實,成為外科手術發現及核磁共振檢查之外的替代工具。針對病患肩部疼痛,我們發表了日常風濕科超音波檢查結果。方法:我們在2010年1月及2012年12月之間於本院風濕科超音波室,回溯性調查共240位病人抱怨肩部疼痛。超音波檢查包含了旋轉肌群、二頭肌腱的長頭、三角肌下-肩峰下滑囊、肩峰鎖骨關節,和肩窩肱骨關節。結果:240位病人中,有140位女性和100位男性,年齡為17歲至89歲,平均為54.31±14.64歲。肩部結構發生病變率分別是脊上肌腱為76.2%、二頭肌肌腱為62.4%、肩胛下肌腱為22.9%、肩窩肱骨關節為20.4%、肩峰鎖骨關節為15.3%、三角肌下-肩峰下滑囊炎為13.3%,及脊下肌腱為9.1%。同時也檢查到夾擠現象為14.1%以及鈣化現象為8.2%。有8位病人超音波顯示無病變產生。此檢查方式的精確率達96.7%。結論:雖然理學檢查可作為診斷和治療肩部疼痛的方法,然而此方式並無法提供診斷的正確性。骨骼肌肉超音波對於肩膀疼痛的病人約97%可提供病變處。

並列摘要


Objective: Research has shown that 15-30% of adults experience shoulder pain at some point during the course of their lives. The sensitivity and specificity of musculoskeletal ultrasound (MSUS) have been validated, showing that this tool can complement surgical findings and magnetic resonance imaging. We report ultrasound findings of patients with shoulder pain in rheumatological daily practice. Methods: The subject population for this retrospective study included 240 patients complaining of shoulder pain at the MSUS department of our rheumatology service between January 2010 and December 2012. The ultrasound examination included views of the rotator cuff, the long head of the biceps tendon, the subacromial-subdeltoid bursa, the acromioclavicular joint, and the glenohumeral joint. Results: Of the 240 patients, 140 were women and 100 were men, with ages ranging from 17 to 89 years and a mean age of 54.31 ± 14.64 years. Alterations of shoulder structures were detected in the supraspinatus tendon (76.2%), biceps tendon (62.4%), subscapularis tendon (22.9%), glenohumeral joint (20.4%), acromioclavicular joint (15.3%), subacromial-subdeltoid bursa (13.3%), and infraspinatous tendon (9.2%). Impingement (14.1%) and calcifications (8.2%) were also detected. Eight patients (3.3%) exhibited no sonographic evidence of any alteration. The sensitivity of the technique was confirmed by the finding of alterations in 96.7% of the cases. Conclusion: Although physical examination allows for a diagnostic approach in the treatment of shoulder pain, the technique is typically not accurate enough to ensure that the correct diagnosis is made. MSUS offered the precision necessary to detect the underlying pathology in 97% of the cases.

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