肩頸肌肉疼痛患者之磁振造影表象的探討

Investigation of the Magnetic Resonance Image Findings of Neck and Shoulder Muscle Pain

許培德(Pei-Der Sheu) ； 王志龍(Jue-Long Wang) ； 林克隆(Ko-Long Lin) ； 施綺娟(Chi-Chuan Shih) ； 孫淑芬(Shwu-Fen Sun) ； 陳坤煌(Kuen-Hwang Chen) ； 黃巧雯(Chiao-Wen Hwang)

《台灣復健醫學雜誌》 33卷2期 (2005/06) Pp. 87-96

https://doi.org/10.6315/2005.33(2)04

摘要

肩頸疼痛是復健科門診經常遇到的疾病，最主要的原因之一是肌肉與筋膜疼痛。肩頸疼痛若是來自於神經壓迫，常可由肌電圖以及影像學檢查來確定診斷（如椎間盤突出、脊椎滑脫或椎間孔狹窄），並給予適當的治療。然而肌肉與筋膜疼痛在現今仍缺乏有效的客觀診斷工具，病人常苦於疾病的不確定性，而到處求醫。
就目前而官，磁振造影是用來評估軟組織最精細的工具，但尚未有文獻報導用來檢查肩頸肌肉疼痛的病人。本研究共選擇27位肩頸及上背部位僵硬酸痛的病患，評估並記錄其疼痛指數、疼痛持續時間、駝背姿勢、關節活動聲響(crepitus or snapping)與疼痛耐受度(pain tolerance)等，並進行磁振造影檢查。希望藉此找出肩頸肌肉疼痛的異常影像表現；並試著發掘上述因子與影像學結果的相關性。
實驗結果顯示，肩頸肌肉疼痛病人在肩胛骨內側緣附近的肌肉與筋膜，T2W影像上呈現高訊號強度，推論是源自於筋膜層穴道位置一氣化氮濃度的升高。在相關因子探討上，關節活動聲響與駝背姿勢二者具有統計上的意義，此結果堆測與肩胛胸壁滑囊積水(scapulothoracic bursa effusion)有關。本實驗的發現尚未被廣泛研究與發表，值得更進一步探討。

關鍵字

肌筋膜疼痛 ； 磁振造影

並列摘要

In the rehabilitation clinic, neck and shoulder pain are mainly attributed to muscle and fascia pain. Neck and shoulder pain resulting from cervical radiculopathy, such as herniated intervertebral disk, spondylolisthesis, and neuroforamen narrowing, can be detected with nerve conduction study, electromyography, and imaging. However, no objective test is available for the diagnosis of muscle and fascia pain.
Although magnetic resonance imaging (MRI) is promising for evaluation of tendon and connective tissue structure, there are no researches for application to neck and shoulder muscle pain. We administered pain questionnaires to 27 patients with soreness of the neck, shoulder, or upper back and recorded their kyphotic posture, crepitus of the scapulothoracic joint, pain duration and pain tolerance. Then, MRI of the neck and shoulder area was performed. The purpose of our study was to apply MRI to detect any abnormal MRI findings in patients with neck and shoulder pain and to investigate the relationship between abnormal imaging findings and clinical factors.
T2-weighted images showed abnormal hyperintensity around the soft tissue of the medial scapular border. The signal intensity change might have resulted from increased nitric oxide content in the acupoits within the interstitial connective tissue plane. MRI-positive findings were significantly related to scapulothoracic crepitus, as well as kyphotic posture, which might have been attributed to effusion involving the scapulothoracic bursa. Because of these interesting findings and the lack of reports published in this field, MRI examination of myofascial pain warrants further exploration.

並列關鍵字

myofascial pain ； magnetic resonance image