以體外震波治療之肩關節鈣化性肌腱炎－個案報告暨文獻回顧

Extracorporeal Shock Wave Therapy for Calcifying Tendinitis of the Shoulder: A Case Report and Systemic Review

李易昌(Yich-Chang Lee) ； 林祖佑(Zu-You Lin) ； 陳聲平(Sheng-Ping Chen) ； 賴旻信(Min-Hsin Lai) ； 羅慶徽(Ching-Hui Loh)

《中華職業醫學雜誌》 19卷3期 (2012/07) Pp. 181-188

https://doi.org/10.30027/CJOM.201207.0006

摘要

肩關節之鈣化性肌腱炎，定義為在肩關節的旋轉肌群韌帶上發生了鈣化，並導致肩關節產生發炎及疼痛的現象。患者常常會因為急性期造成的嚴重疼痛、肩關節活動限制所帶來生活上的不便、或持續性的疼痛而前往醫院就診。在臨床上分為鈣化前期、鈣化期、與鈣化後期。治療的方法，以保守治療為主，包括口服NSAID類藥物、物理治療、肩峰下注射類固醇、插針灌洗、及體外震波治療。如經過保守治療6個月後仍無法改善，才建議手術治療。以體外震波來治療鈣化性肌腱炎越來越普遍，而目前文獻也普遍認為有一定的效果，但是對於治療時震波傳導的能量、傳導的頻率、治療的次數與間隔時間、以及是否使用局部麻醉等，到目前為止仍然沒有一定的共識。本文報告一位30歲的男性軍人，在使用肌肉骨骼軟組織超音波確診為罹患肩關節鈣化性肌腱炎後，以口服藥物及物理方式治療約3個月仍無效的情況下，合併體外震波治療後成功的案例，並回顧相關文獻，以期能使臨床醫師對以體外震波治療此疾病有更深入的了解。

關鍵字

鈣化性肌腱炎 ； 旋轉肌群韌帶 ； 肩關節 ； 體外震波

並列摘要

Calcifying tendinitis of the shoulder is defined as calcific change over the rotator cuff of the shoulder, and it induces local inflammation and painful sensation. Patients often need medical treatment due to the serious pain in the acute phase, the inconvenience in daily life resulted from the limited range of motion of the shoulder or the persistent pain. It goes through three distinct stages clinically: pre-calcific stage, calcific stage and post-calcific stage. Conservative treatment includes oral NSAIDs, physiotherapy, subacromial corticosteroid injection, needle aspiration and lavage as well as extracorporeal shock wave therapy (ESWT). Surgical treatment will be taken into consideration when a patient has persistent symptoms after a conservative treatment for more than 6 months. The ESWT for calcifying tendinitis is adopted more and more frequently, however, no consensus has yet been reached with respect to the quantity of shock wave to conduct, the frequency of shock wave to conduct, the times of treatment, the interval time, the method of positioning as well as with or without local anesthesia.This article is a case report about a 30-year-old solider, suffering from calcifying tendinitis, identified by using ultrasound imaging of the musculoskeletal and soft tissue of the shoulder. He had persistent symptoms after a treatment of oral medications with physiotherapy for about 3 months, but then was finally cured with success by the ESWT. It is expected that, on the basis of the related literature, this article could provide more information for the clinicians who decide to adopt the EWST for the treatment of this disease.

並列關鍵字

calcifying tendinitis ； rotator cuff ； shoulder ； extracorporeal shock wave therapy