以超音波來診斷肱二頭肌長頭肌腱斷裂之陷阱：病例報告

A Pitfall of Using Ultrasonography in Evaluating Ruptured Long Head Tendon of the Biceps Brachii: A Case Report

施建宏(Chien-Hung Shih) ； 林仲哲(Chung-Che Lin) ； 陳怡如(I-Ru Chen) ； 李雅芳(Ya-Fang Lee)

《台灣復健醫學雜誌》 34卷2期 (2006/06) Pp. 103-110

https://doi.org/10.6315/2006.34(2)06

摘要

骨骼軟組織超音波目前已被廣泛應用到肩關節肌腱病變的診斷，對於肱二頭肌長頭肌腱病變有良好的準確率，當該肌腱斷裂回縮時，影像檢查可能出現空盪之肱二頭肌腱溝(empty groove sign)而找不到長頭肌腱。我們報告的病例是一位55歲男性，於兩年前因為拉單槓造成右肩肱二頭肌長頭肌腱斷裂，超音波檢查發現肱二頭肌腱溝內仍有回音性之物體存在，令超音波檢查者在乍看之下以為長頭肌腱仍然完整，然而由縱切面仔細觀察，發現肱二頭肌腱溝內的物體並不具肌腱該有的非等方性(anisotropy)及纖絲狀排列(fibrillar pattern)，為疤痕組織將肱二頭肌腱溝填滿，剩餘的低回音缺損(hypoechoic defect)僅可於肌腱肌肉會合處附近發現，核磁共振造影證實附著於關節盂上唇的肱二頭肌長頭肌腱斷裂回縮。若病人肱二頭肌長頭肌腱斷裂已久，使用超音波來檢查時，需特別小心這種陷阱。

關鍵字

肱二頭肌 ； 肌腱 ； 超音波

並列摘要

Musculoskeletal ultrasonography is a widely used diagnostic tool to visualize shoulder tendon pathology. The diagnostic accuracy for biceps tendon pathology is high. An empty groove may be seen when there is complete rupture, and the long head tendon markedly retracts into the arm. We report a case of ruptured tendon of the right biceps brachii in a 55-year-old male injured during pull-up exercise 2 years ago. Sonography demonstrated the presence of echoic material filling the bicipital groove. This material erroneously resembled the biceps tendon and resulted in a false first impression of intact tendon. However, a careful longitudinal scan failed to show the anisotropy and fibrillar pattern of the tendon. The bicipital groove was filled with amorphous fibrous scar tissue and the hypoechoic defect could only be detected in the area close to muscle-tendon junction. Magnetic resonance imaging demonstrated rupture of the long head tendon at the insertion of superior glenoid labrum and retraction distally. Physicians should be alert to this pitfall of using ultrasonography if the long head tendon has been ruptured for a long time.

並列關鍵字

biceps brachii ； tendon ； ultrasonography