超音波檢查肩部肱二頭肌腱長頭時探頭位置之研究

Investigation of the Probe Position for Ultrasonography of the Long Head of the Biceps Brachii Tendon

姜義彬(Yi-Pin Chiang) ； 徐敏容(Min-Jung Hsu) ； 劉盈宏(Ying-Hung Liu) ； 李佳(Chia Lee)

《台灣復健醫學雜誌》 34卷3期 (2006/09) Pp. 149-156

https://doi.org/10.6315/2006.34(3)03

摘要

本研究以肩關節掃描為例，將探頭置於觀察肩部肱二頭肌腱長頭之最佳位置，並由專人測量此位置下探頭長軸與受測者前臂間之夾角，經由探討此夾角之分佈狀況，提供初學者快速而正確找到肩部掃描標的物（肱二頭肌腱長頭）之方法。
本研究以民國92年間平均年齡為50.8±12.5歲之33名男性及67名女性為對象，共檢查200例肩關節。實驗時以超音波探頭置於受測者肩部肱骨大小結節間之二頭肌腱溝，向下移動至二頭肌溝中段，超音波下呈現二頭肌腱溝內面積最大處，並藉由調整探頭－前臂夾角使大小結節之表面在螢幕中為同一水平面之位置，本研究訂此處為觀察肱二頭肌腱長頭及橫肱韌帶之最佳位置，此位置下探頭長軸與受測者前臂間之夾角稱為此肩關節之「最佳探頭－前臂夾角」。研究結果發現，受測者左右兩肩之「最佳探頭－前臂夾角」測量值分別為16.2±8.2度及16.1±8.7度，且前臂相對於探頭長軸均為內旋之位置。200例肩關節之「最佳探頭－前臂夾角」出現於12-15度加減10度區間內之機率均大於75%。本研究結果建議肩部超音波掃描之初學者在掃描肱二頭肌腱長頭時，受測者肘部彎曲，前臂置於受測者大腿，不論患者前臂的擺位方向，超音波探頭之長軸宜首先置於相對於前臂為外旋12-15度開始進行檢查，則較其他起始掃描角度，更容易測到檢查之標的物，即二頭肌腱溝內之肱二頭肌腱長頭。

關鍵字

超音波 ； 肱二頭肌

並列摘要

Musculoskeletal ultrasound has been utilized in rehabilitation medicine for many years. However, the accuracy and speed of the examination are very operator-dependent. It is often difficult for inexperienced operators to locate target structures quickly. We therefore designed this study to determine the best positioning for the transducer to detect the tendon of the long head of the biceps brachii on shoulder ultrasonography.
One hundred people (200 shoulders) were recruited, including 33 men and 67 women, with a mean age of 50.8±12.5 years. Patients sat upright with the arm flexed and the forearm supinated. The ultrasound transducer was placed on the anterior aspect of the shoulder, and the examiner manipulated it to show the largest area of the bicipital groove between the greater and lesser tuberosities. Once the largest groove area was identified, the transducer was carefully adjusted so that the surface of the greater and lesser tuberosities were seen on an even horizontal plane. We defined the angle between the long axis of the transducer and the subjects' forearm as the ”best transducer-forearm angle”. By scanning up and down the vertical plane, the tendon of the long head of the biceps was easily identifiable. The average best transducer-forearm angle in this series was 16.2±8.2 degrees for left shoulders and 16.1±8.7 degrees for right shoulders. Among the 200 scanned shoulders, 75% of the transducer-forearm angles were clearly delineated with the shoulder internally rotated 12 to 15 degrees with respect to the transducer angle.
For examiners who are beginning to learn shoulder ultrasonography, we recommend placement of the transducer on the anterior shoulder with the arm at 12 to 15 degrees of internal rotation relative to the transducer. They should then scan along the vertical plane to identify the tendon of the long head of the biceps.

並列關鍵字

ultrasonography ； biceps brachii