Zusammenfassung
Ziel dieser Untersuchung war es, die Wertigkeit der Ultraschalluntersuchung zur Diagnostik schmerzhafter Veränderungen hemiplegischer Schultergelenke nach zerebrovaskulärem Insult zu evaluieren. Es wurden 41 Patienten untersucht, wobei jeweils die kontralaterale Schulter als Kontrollorgan diente. Ultrasonographisch pathologische Veränderungen fanden sich bei 33 hemiplegischen und bei 15 nicht hemiplegischen Schultern, meist als Bizepssehnentendinitis, daneben auch als Supraspinatuseinriss, Kalzifikation, Irregularität am Humeruskopf und Veränderung des AC-Gelenks. Die Ultrasonographie erwies sich dabei als nützliche und effektive Methode zur Diagnostik.
Abstract
Purpose: To assess the usefulness of ultrasound in diagnosing pathologies of shoulders in patients with painful hemiplegic shoulders caused by cerebro-vascular accident (C.V.A.). Methods: Ultrasound (U.S.) was used in forty-one patients with hemiplegic shoulders. Review of patients presenting at our musculo-skeletal orthopedic unit. The non-hemiplegic shoulders served as a control group. Results: Ultrasound pathologies were found in thirty-three hemiplegic shoulders and in fifteen non-hemiplegic shoulders. Bicipital tendonitis was the most common finding. Other pathologies included supraspinatus tear, calcification, humeral head irregularities and acromio-clavicular joint (A.C.J.) changes. Conclusions: As in many other soft tissue lesions ultrasonography is a useful and effective tool in evaluation of pathology of hemiplegic shoulders.
References
1
Dekker J HM, Wagenaar R C, Lankhorst G J, de Jong B A.
The painful hemiplegic shoulder: effects of intra-articular triamcinolone acetonide.
Am J Phys Med Rehabil.
1997;
76
43-48
2 Fornage B D. Musculoskeletal Evaluation. Mittelstaedt CA General Ultrasound. Churchill Livingstone Inc. 1992: 20-21
3
Hakuno A, Sashika H, Ohkawa T, Itoh R.
Arthrographic findings in hemiplegic shoulders.
Arch Phys Med Rehabil.
1984;
65
706-711
4
Hall F M.
Sonography of the shoulder.
Radiology.
1989;
173
310
5
Joynt R L.
The source of shoulder pain in hemiplegia.
Arch Phys Med Rehabil.
1992;
73
409-413
6
Lee C L, Chen T W, Weng M C, Wang Y L, Cheng H S, Huang M H.
Ultrasonographic findings in hemiplegic shoulders of stroke patients.
The Kaohsiung Journal of Medical Sciences.
2002;
18
70-76
7
Lee K H, Khunadorn F.
Painful shoulder in hemiplegic patients: a study of the suprascapular nerve.
Arch Phys Med Rehabil.
1986;
67
818-820
8
Mack L A, Nyberg D A, Matsen III F A.
Sonographic evaluation of the rotator cuff.
Radiol Clin North Am.
1988;
26
161-177
9
Middleton W D, Edelstein G, Reinus W R, Melson C M, Totty W G, Murphy W A.
Sonographic detection of rotator cuff tears.
Am J Roentgenol.
1985;
144
349-353
10
Middleton W D, Reinus W R, Totty W G, Melson C M, Murphy W A.
Ultrasonographic evaluation of the rotator cuff and biceps tendon.
J Bone Joint Surg.
1986;
68
440-450
11
Middleton W D, Reinus W R, Totty W G, Melson W G, Murphy W A.
US of the biceps tendon apparatus.
Radiology.
1985;
157
211-215
12
Middleton W D.
Ultrasonography of the shoulder.
Radiol Clin N Am.
1992;
30
927-940
13
Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M.
Rotator-cuff changes in asymptomatic adults.
J Bone Joint Surg.
1995;
77
296-298
14
Poulin de Courval L, Barsauskas A, Berenbaum B. et al .
Painful shoulder in the hemiplegic and unilateral neglect.
Arch Phys Med Rehabil.
1990;
71
673-676
15
van Holsbeeck M, Introcaso J.
Sonography of the postoperative shoulder.
AJR.
1989;
153
152-202
16
Van Ouwenaller C, Laplace P M, Chantraine A.
Painful shoulder in hemiplegia.
Arch Phys Med Rehabil.
1986;
6
23-36
17
Vick C W, Bell S A.
Rotator cuff tears: diagnosis with sonography.
Am J Roentgenol.
1990;
154
121-123
A. Blankstein
Department of Orthopedic Surgery and Diagnostic Imaging The Chaim Sheba Medical Center
Ramat Gan 52621
Israel
Telefon: + 972-3-530 3030
Fax: + 972-3-549 4269
eMail: blankali@zahav.net.il