Stroke with Hemiplegic Shoulder Pain Due to Pigmented Villonodular Syiular Svnovitis-A Case Report

中風合併色素絨毛結節性滑膜炎致患肢肩痛：病例報告

王邦元(Pong-Yuen Wong) ； 孫翼龍(Yi-Lung Sun) ； 鄧復旦(Fuk-Tan Tang) ； 方朝銘(Chao-Ming Fang) ； 李志明(Chi-Ming Lee) ； 張良慈(Liang-Tzu Chan)

《中華民國復健醫學會雜誌》 23卷2期 (1995/12) Pp. 167-172

摘要

色素絨毛結節性滑膜炎主要為侵犯關節滑膜並產生血鐵質沉澱、絨毛性增生之病變。其引起之原因並不十分明確，但一般認為可能為（1）發炎性（2）贅生物（3）創傷性所引起，而且好發於下肢之膝，髖、踝及上肢之肘關節，但發生在肩騎節之機率並不常見。患肢肩痛為中風病患常見之合併症，其發生機率略為5-84%左右，其中較常見之原因為：肩關節脫垂、拉傷、攣縮或反射性交感神經系統失調。因色素絨毛結節性滑膜炎所導致之患肢肩痛甚為罕見，故本病例提出加以討論。
本篇病例報告一位72歲男性病患於民國83年1月3日因左側丘腦出血合併右側偏癱入院治療，83年3月25日因右肩疼痛合併閤節活動度限制，於關節腔穿刺檢查中發現關節血腫，關節液分析糖份輕度下降，白血球1000/cumm，粘蛋自凝塊反應尚佳：（十）。核磁共振檢查發現關節內滑膜增生及血鐵質沉澱。滑膜病理組織學檢查中發現，滑膜細胞呈乳頭狀增生及血鐵質色素沉澱。因此種病例於肩部發生並不常見，故中風病患之患側肩痛時需作為鑑別診斷之一，以為評估及治療上之參考。

並列摘要

Pigmented villonodular synovitis is an uncommon disorder characterized by synovial proliferation and hemosiderin deposition into the synovial lining of the affected joints, tendon sheaths and bursae. Its etiology is not fully known, however, inflammation, neoplasm and trauma have been postulated. It commonly affects the knee, hip, ankle and elbow joints, but rarely, the shoulder and its bursae. Shoulder pain is a common complication present in the stroke patients and its incidence varies from 5% to 84%. Shoulder subluxation, traction injury, contracture and reflex sympathetic dystrophy are the common causes of shoulder pain, whereas, pigmented villonodular synovitis is a very rare cause. The present report was to describe a case of stroke patient with shoulder pain caused by pigmented villonodular synovitis.
A 72-year-old male patient was admitted due to left thalamic hemorrhage with right hemiplegia on January 3, 1994. Right shoulder pain associated with limited passive range of motion was noted during admission. Shoulder joint synovial fluid aspiration yielded a bloodtinged, brown fluid and the cytologic analysis revealed a low glucose content, low inflammatory cell count and a fair mucin clot. The magnetic resonance imaging showed localized hypertrophic synovium and hemosiderin deposit. Pathologic examination showed villous projection, hemosiderin deposit and prohferative synovial cells. Although uncommon, pigmented villonodular synovitis should be considered in the differential diagnosis of hemiplegic shoulder pain in the stroke patients.

並列關鍵字

stroke ； hemiplegia ； pain ； shoulder ； pigmented villonodular synovitis