超声诊断肩袖撕裂

目的 探讨直接及间接超声征象对肩袖撕裂分型的诊断价值。方法 收集52例于我院行肩关节镜手术的患者,所有患者均接受超声检查,计算直接、间接超声征象诊断肩袖撕裂的效能,并比较直接超声征象诊断肩袖撕裂亚型与关节镜结果的一致性。结果 直接征象诊断肩袖有无撕裂、全层撕裂、部分撕裂的准确率分别为90.38%（47/52）、96.15%（50/52）和86.54%（45/52）,且直接征象诊断肩袖撕裂亚型与关节镜结果的一致性较好。在间接征象中,3部位同时出现积液（肩峰下-三角肌下滑囊积液、肩关节腔积液及肱二头肌长头腱腱鞘积液）、三角肌滑囊疝及软骨分界征诊断肩袖撕裂的特异度分别为80.95%（17/21）、90.48%（19/21）及95.24%（20/21）。结论 直接联合间接超声征象诊断肩袖撕裂的分型具有较高的临床应用价值。     

基于经皮肩部穿刺超声造影诊断肩袖撕裂的一致性

目的 观察基于经皮肩部穿刺超声造影（CEUS）诊断各型肩袖撕裂（RCT）的一致性。方法 回顾性分析94例临床疑诊RCT患者的肩部二维超声、CEUS[单一经皮超声引导肩峰下滑囊超声造影（PUSB）或联合经皮超声引导肌腱病损区超声造影（PUTL）]及关节镜检查资料,分别由观察者1（主任医师）、观察者2（主治医师）、观察者3（住院医师）基于肩部穿刺CEUS评估有无RCT及其类型,观察其诊断一致性及效能。结果 94例中,关节镜检出17例较大全层撕裂（lF）、14例小全层撕裂（sF）、18例滑囊侧部分撕裂（bP）、23例关节侧部分撕裂（aP）及22例无撕裂（NT）。观察者间对全部病例的评估结果的一致性为较高或高（Kappa=0.67~0.95）。针对全层撕裂（FT）、部分撕裂（PT）、lF、sF、bP、aP和NT,观察者1 vs. 2、2 vs. 3的一致性均高（Kappa=0.81~0.95）、观察者1 vs. 3均较高（Kappa=0.71~0.80）。观察者诊断RCT的准确率为87.23%~96.81%。针对RCT,观察者3诊断bP的敏感度为77.78%（14/18）,3名观察者诊断的敏感度及特异度均>80.00%,对lF及NT的诊断敏感度均为100%（17/17）及90.91%（20/22）。结论 经皮肩部穿刺CEUS诊断各型RCT的一致性及敏感度、特异度均较高。     

MRI检查在肩关节损伤的临床应用

目的评价MRI检查在肩关节的临床应用。方法分析31例肩关节常规MRI检查和17例肩关节MRI造影检查的形态学特点。结果扫描发现肩袖完全撕裂、肩袖部分撕裂、肌腱炎、盂唇撕裂、关节积液、肱二头肌长头腱损伤等;常规MRI诊断关节盂唇撕裂的敏感性为78％,特异性为88％;诊断肩袖部分撕裂敏感性为80％,特异性均为75％,诊断肩袖完全撕裂的敏感性为95％,特异性为88％。MRI肩关节造影诊断肩袖部分撕裂的敏感性为91％,特异性为100％;肩袖完全撕裂的敏感性为95％,特异性为100％;诊断关节盂唇撕裂的敏感性为78％,特异性为88％。结论肩关节MRI能清晰显示出肩关节的复杂解剖结构,肩关节MRI造影能清晰显示肩袖、关节盂唇等正常机病理情况,对肩关节损伤的诊断和鉴别诊断具有较高的价值。     

The Value of Percutaneous Shoulder Puncture with Contrast-enhanced Ultrasound in Differentiation of Rotator Cuff Tear Subtypes: A Preliminary Prospective Study

Imaging tests perform relatively well in the detection of rotator cuff tears (RCTs), exhibiting high sensitivity and specificity, mainly among larger full-thickness tears (tear width >1 cm). However, these tests are relatively less accurate in the detection of small full-thickness tears and partial-thickness tears. The purpose of this study was to determine the feasibility of percutaneous ultrasound-guided tendon lesionography (PUTL) using the SonoVue and the value of percutaneous shoulder puncture via contrast-enhanced ultrasound (CEUS)—a combination of percutaneous ultrasound-guided subacromial bursography (PUSB) and PUTL—in the detection of RCT subtypes. Conventional ultrasound (US), CEUS and magnetic resonance imaging (MRI) were performed and prospectively evaluated in 97 patients who had undergone arthroscopy because of suspected RCTs. The rates of detection of the various subtypes of RCTs using CEUS, PUSB, PUTL, US and MRI were evaluated. The RCT subtype detection rate via CEUS was significantly higher than the rates via US and MRI (96.9%, 74.2% and 76.3%, respectively), as were the detection rates for small full-thickness tears combined with partial-thickness tears (98.2%, 60.0% and 61.8%, respectively). The detection rate with PUSB was significantly higher than those with US and MRI in assessing full-thickness tears combined with bursal-side partial-thickness tears (93.9%, 65.3% and 65.3%, respectively). The detection rate with PUTL was significantly higher than those with US and MRI in assessing the corresponding subtypes (100.0%, 69.2% and 76.9%, respectively). On the basis of our findings, we consider PUTL a tolerable and feasible procedure. Percutaneous shoulder puncture using CEUS can be an effective alternative method with better diagnostic performance than US and MRI for the detection of RCT subtypes.     

Sonography of partial-thickness quadriceps tendon tears with surgical correlation.

OBJECTIVE: With the use of surgical findings as the reference standard, the purpose of this study was to describe the sonographic findings of partial-thickness and complete tears of the quadriceps tendon and to determine whether sonography can potentially aid diagnosis. METHODS: Three hundred eighty-nine consecutive sonographic reports (January 1996 to April 2001) of the knee/quadriceps tendon were reviewed retrospectively and assessed for subsequent surgery on the quadriceps tendon. Seven cases were thus identified. Findings at surgery (complete versus partial tears) were compared with the original sonography reports. RESULTS: All 4 partial tears and 1 of 2 complete tears were diagnosed correctly on the basis of sonography. One complete tear was described as a partial tear on the basis of sonography. In a seventh case, complete disruption of the extensor mechanism with osseous avulsion of the superior pole of the patella was identified correctly. Dynamic scanning was essential in diagnosing a partial quadriceps tendon tear in 1 case. CONCLUSIONS: Sonography, including the use of dynamic evaluation, was helpful in the diagnosis of partial-thickness tears of the quadriceps tendon and may aid in differentiation of such cases from complete quadriceps tendon tears, particularly in the acute setting. The presence of scar tissue in the setting of chronic injury may represent a potential pit-fall in the assessment of partial versus complete quadriceps tears. Further study is needed to define the accuracy of sonography for detecting quadriceps tendon tears.     

Ultrasonographic-surgical correlation of ankle tendon tears.

This study evaluates the accuracy of ultrasonography in detecting ankle tendon tears of the peroneal, posterior tibial, and flexor digitorum longus tendons based on operative findings and clinical follow-up. A prospective study was performed in 33 patients with clinically suspected tendon injury. Sixty-eight tendons were evaluated sonographically. The diagnosis of an intrasubstance tear was made when disruption of uniform tendon architecture by hypoechoic linear or globular clefts was observed. Criteria used to diagnose complete tendon rupture included discontinuity or gap within the tendon or complete nonvisualization of the tendon. Treatment decisions were based on a combination of clinical parameters and imaging studies. Twenty-six patients had the presence or absence of tear confirmed at surgery. Five patients had a final diagnosis based on clinical findings, and two were lost to follow-up. Of the 68 tendons evaluated sonographically, 54 were directly inspected at surgery; 20 were found to be torn and 34 were intact. Ultrasonography was able to identify all tears correctly with an accuracy of 93%, a sensitivity of 100%, and a specificity of 88%. The positive and negative predictive values were 83% and 100%, respectively. The combined accuracy, sensitivity, and specificity of ultrasonography in detecting tendon tears in all patients evaluated both surgically and by clinical follow-up were 94%, 100%, and 90%, respectively.     

US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay

The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination.A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT).     

Sonographic features of dialysis-related amyloidosis of the shoulder.

This study evaluated the diagnostic role of ultrasonography in dialysis-related amyloidosis in shoulders of chronically hemodialyzed patients. Fourteen shoulders of 12 long-term hemodialysis patients were examined. All patients had been on dialysis for at least 10 years. All patients had varying degrees of pain and limitations of movement in the studied shoulders. Dialysis-related amyloidosis was the presumed diagnosis in all patients. Any patient with a history of any disease, other than dialysis-related amyloidosis, capable of producing a pathologic shoulder condition was excluded. The following parameters were studied: supraspinatus and biceps tendon thickness, tendon tears, synovial thickening, and the presence of hypoechoic material around tendons and within bursae. All shoulders had a nonhomogeneous thickening, greater than 7 mm, of the supraspinatus tendon. Seven shoulders (50%) had abnormal thickening of the biceps tendon (4 mm or greater), and two shoulders had abnormal thickening of the subscapularis tendon. Hypoechoic deposits were seen in the subdeltoid bursae and biceps sheaths in five and six shoulders, respectively. Three shoulders showed partial tears of the supraspinatus tendon, one shoulder showed a tear in the biceps tendon, and one shoulder had a tear in the subscapularis tendon. Ultrasonography is an excellent imaging modality in diagnosing the presence of dialysis-related amyloidosis in symptomatic shoulders of long-term hemodialysis patients, without having to resort to invasive procedures. The results of previous studies have been confirmed and new ultrasonographic findings described. Of particular interest is the involvement of the subscapularis tendon in dialysis-related amyloidosis. Repeat ultrasonography can become an important way to follow-up progression of shoulder dialysis-related amyloidosis in hemodialyzed patients.     

高频超声诊断冈上肌腱撕裂

目的观察冈上肌腱撕裂超声声像图特征,评估高频超声诊断冈上肌腱撕裂的效能。方法纳入65例(65肩)超声诊断为冈上肌腱撕裂患者,以同期10名健康志愿者(20肩)为对照,对比超声与关节镜术中诊断结果,采用Cohen's Kappa系数分析二者诊断的一致性,评价超声诊断效能。结果冈上肌腱撕裂超声多表现为无回声、肌腱滑囊面凹陷及连续性不佳,据以诊断撕裂的敏感度分别为85.42%、89.58%及93.75%,特异度分别为76.47%、100.00%及76.47%;超声根据肌腱滑囊面凹陷诊断冈上肌腱撕裂与关节镜术中诊断的一致性最佳(Kappa=0.818),其次为肌腱连续性不佳(Kappa=0.716)及无回声区(Kappa=0.586)。超声根据上述特征诊断与关节镜术中诊断差异均无统计学意义(P均>0.05)。结论高频超声可较准确地诊断冈上肌腱撕裂;根据滑囊面凹陷诊断与关节镜诊断冈上肌腱撕裂的一致性最佳;回声特点结合动态观察肌腱连续性有助于减少漏、误诊。     

Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: results from 58 sonographic examinations with surgical correlation

PURPOSE: To assess the value of sonography as an isolated diagnostic test for the detection and quantification of rotator cuff tears. METHODS: Preoperative sonographic examination was performed on 58 shoulders. Key biases on sonographic interpretation such as history-taking, physical examination, or concurrent imaging examinations were excluded by way of blinding. Tears of the rotator cuff were the positive findings of interest. Assessment of tear size and localization was done sonographically, and the results were compared with operative findings. RESULTS: All 24 full-thickness tears observed at surgery had been diagnosed correctly via sonography. In 19 of 20 cases with an intact rotator cuff, preoperative sonography was negative. Thirteen of 14 partial-thickness tears were not detected via sonography; 1 was misinterpreted as a full-thickness tear. Location of the tears relative to the rotator cuff tendons was described correctly in 21 of 25 cases. For tear size measurement, the 95% range of agreement was less than +/-1 cm. CONCLUSIONS: Blinded sonographic examination is effective in the detection and quantification of full-thickness tears of the rotator cuff but lacks sensitivity in the detection of partial-thickness tears.     

Sonographic findings of pectoralis major tears with surgical, clinical, and magnetic resonance imaging correlation in 6 patients.

OBJECTIVE: The purpose of this research was to describe the sonographic findings of pectoralis major injuries with clinical, surgical, and magnetic resonance imaging (MRI) correlation. METHODS: Images from sonographic examinations of the pectoralis major muscle of 6 patients were retrospectively evaluated and characterized. The sonographic findings were compared with clinical, surgical, and MRI findings. RESULTS: The 6 patients were male (mean age, 30 years) with injuries sustained during weight lifting, football, and shotgun firing. Two of the 6 patients had MRI correlation; 1 had surgical correlation; 2 had both surgical and MRI correlation; and 1 had clinical follow-up. The sternal head was injured in 5 patients; 4 involved the musculotendinous junction, and 1 involved the distal tendon. The sonographic findings of muscle fiber retraction and surrounding hemorrhage allowed identification of the affected muscle. Direct impact injury causing hematoma involved the clavicular head in 1 patient. In total, 5 cases were partial-thickness pectoralis major tears, whereas complete distal tendon disruption was found in 1. CONCLUSIONS: Sonographic imaging longitudinal to the pectoralis muscle fibers showed fiber disruption, retraction, and possible hypoechoic or anechoic hematoma, most commonly involving the musculotendinous junction of the sternal head. Distal tendon assessment is important to evaluate for a full-thickness pectoralis major tear.     

Introduction to musculoskeletal diagnostic ultrasound: examination of the upper limb

With recent advances in computer technology and equipment miniaturization, the clinical application of diagnostic ultrasonography (U/S) has spread across various medical specialties. Diagnostic U/S is attractive in terms of its noninvasiveness, lack of radiation, readiness of use, cost-effectiveness, and its ability to make dynamic examinations possible. Dynamic imaging deserves special emphasis because it is useful in differentiating full-thickness from partial-thickness tendon tears, muscle tears, and tendon and nerve subluxations or dislocations. It is also a quick and easy avenue for side-to-side comparisons. When appropriately used, diagnostic U/S can be considered as an extension of one's physical examination. However, there are limitations of U/S, which will be discussed in this review article. This is part 1 of two articles; this first part will focus on the ultrasound examination of the upper extremity, using selected examples relevant to musculoskeletal medicine. Part 2 will cover common pathologies of the lower extremity.     

Diagnostic value of clinical tests for degenerative rotator cuff disease in medical practice

ObjectivesTo assess the diagnostic value of clinical tests for degenerative rotator cuff disease (DRCD) in medical practice.MethodsPatients with DRCD were prospectively included. Eleven clinical tests of the rotator cuff have been done. One radiologist performed ultrasonography (US) of the shoulder. Results of US were expressed as normal tendon, tendinopathy or full-thickness tear (the reference). For each clinical test and each US criteria, sensitivity, specificity, negative predictive value and positive predictive value, accuracy, negative likelihood ratio (NLR) and positive likelihood ratio (PLR) were calculated. Clinical relevance was defined as PLR ≥2 and NLR ≤0.5.ResultsFor 35 patients (39 shoulders), Jobe (PLR: 2.08, NLR: 0.31) and full-can (2, 0.5) test results were relevant for diagnosis of supraspinatus tears and resisted lateral rotation (2.42, 0.5) for infraspinatus tears, with weakness as response criteria. The lift-off test (8.50, 0.27) was relevant for subscapularis tears with lag sign as response criteria. Yergason's test (3.7, 0.41) was relevant for tendinopathy of the long head of the biceps with pain as a response criterion. There was no relevant clinical test for diagnosis of tendinopathy of supraspinatus, infraspinatus or subscapularis.ConclusionsFive of 11 clinical tests were relevant for degenerative rotator cuff disease.     

超声诊断类风湿性肩关节炎肩袖损伤：与关节镜手术对照

目的 探讨超声检查对类风湿性肩关节炎肩袖损伤的诊断价值。方法 应用超声对47例临床拟诊肩袖损伤的类风湿性肩关节炎患者的47侧肩袖进行扫查,依次观察肩胛下肌腱、冈上肌腱、冈下肌腱、小圆肌腱在静止状态和运动状态下有无损伤及撕裂。 在超声检查1周内对所有患者行肩关节镜手术治疗,将超声结果与手术结果进行对照。结果 超声可清晰显示类风湿性肩关节炎肩袖病变的形态学特征,包括有无撕裂和厚度改变;共检出31侧肩袖损伤,其中不完全撕裂18侧,完全撕裂7侧,肩袖肌腱厚度变薄6侧。与关节镜手术结果比较,超声诊断肩袖损伤的总体敏感度为90.62%(29/32),特异度为86.67%(13/15),准确率为89.36%(42/47)。超声对肩袖完全撕裂的诊断准确率为100%(7/7)。结论 超声对检出和判断类风湿性肩关节炎肩袖损伤程度有较高价值,尤其对显示完全撕裂和肩袖肌腱厚度变薄意义更显著。     

The value of ultrasonography in the detection of meniscal tears diagnosed by magnetic resonance imaging

OBJECTIVE: To evaluate the diagnostic value of ultrasonography in meniscal tears that were diagnosed by magnetic resonance imaging (MRI). DESIGN: Twenty-seven knees with meniscal tears and 14 knees without tears on MRI were prospectively evaluated. A radiologist performed the ultrasonography and evaluated the presence and locations of the meniscal tears. MRI was used as the reference standard. RESULTS: Twenty-nine menisci with tears and 53 menisci without tears were identified by MRI. Twenty-two tears were in the medial menisci, and seven tears were in the lateral menisci. In the 29 meniscal tears, the ultrasonographic diagnosis was correct in 25 (86.2%) and incorrect in 4 (13.8%) menisci. In the 53 menisci without tears, the ultrasonographic diagnosis was correct in 45 (84.9%) and incorrect in 8 (15.1%) menisci. Ultrasonography showed a sensitivity, specificity, accuracy, and positive and negative predictive values for meniscal tears of 86.2%, 84.9%, 85.4%, 75.8%, and 91.8%, respectively. Of the four intracapsular injuries observed by MRI in injured knees, an osteochondritis dessecans was only observed by ultrasonography. CONCLUSIONS: Ultrasonography is an accurate imaging study for diagnosing meniscal tears. The results correlated with those obtained by MRI; this suggests that ultrasonography can be a useful imaging modality in uninjured knees.     

Associations of Sonographic Abnormalities of the Shoulder with Various Grades of Biceps Peritendinous Effusion (BPE)

Bicipital peritendinous effusion (BPE), a common ultrasonographic finding of the long head of the biceps tendon, may be associated with shoulder joint derangement, but supporting evidence from large-scale studies is lacking. The aim of this cross-sectional study was to determine the strength of the association between BPE and sonographic abnormalities of the shoulder joint. We reviewed the sonographic reports of patients with suspected shoulder disorders investigated ultrasonographically between January 2011 and January 2012. BPE was graded according to its measured thickness as absent (<1 mm), mild (1–2 mm), moderate (2–3 mm) or severe (>3 mm). The associations between BPE and sonographic abnormalities were examined using multinomial logistic regression adjusted for age, gender, affected side and clinical diagnosis of frozen shoulder. The prevalence rates of absent, mild, moderate and severe BPE among the 907 shoulders examined were 64.1%, 17.8%, 10.4% and 7.7%, respectively. Frozen shoulder was associated with mild BPE (relative risk [RR] vs. participants without BPE = 1.83, 95% confidence interval [CI] = 1.28–2.50). Sonographic findings of biceps tendinopathy, subdeltoid bursitis and full-thickness tears of the supraspinatus tendon were significantly associated with the entire spectrum of BPE, whereas subscapularis tendon tears were significantly associated with moderate (RR = 2.47, 95% CI = 1.29–4.69) and severe (RR = 3.11, 95% CI = 1.51–6.33) BPE. Severe BPE was associated with articular-sided partial-thickness tears of the supraspinatus tendon (RR = 14.32, 95% CI = 4.30–34.35), posterior recess effusion (RR, 7.98, 95% CI = 1.44–34.93) and biceps medial subluxation (RR = 7.25, 95% CI = 1.90–22.33). Our study indicates that BPE is related to various shoulder abnormalities and that the strengths of these associations depend on the severity of BPE. Clinicians encountering BPE should grade its severity and be alert for hidden lesions of the shoulder joint.     

The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation

Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation.

Objective

To investigate whether the lag signs were valid tools in diagnosing full-thickness tears of the rotator cuff.

Design

A same-subject, correlation, double-blinded design was used. The results of the external rotation lag sign, drop sign, and internal rotation lag sign were compared with the criterion standard of diagnostic ultrasound to establish their accuracy.

Setting

A regional orthopedic hospital.

Participants

Consecutive subjects (N=37), 21 women and 16 men, with shoulder pain referred to a consultant orthopedic surgeon specializing in shoulder conditions were recruited for this investigation.

Interventions

Not applicable.

Main Outcome Measures

Sensitivity, specificity, and positive and negative likelihood ratios of the lag signs when using ultrasound as the reference test.

Results

The specificities of the drop sign and internal rotation lag sign were 77% and 84%, respectively, which, together with low positive likelihood ratios 3.2 (95% confidence interval [CI], 1.5-6.7) and 6.2 (95% CI, 1.9-12.0), indicate that a positive result was poor at recognizing the presence of full-thickness tears. The drop sign had a sensitivity of 73% with a negative likelihood ratio of .34 (95% CI, 0.2-0.8), suggesting that a negative test was fair at ruling out the presence of full-thickness tears. The sensitivity of the internal rotation lag sign (100%) supported by the negative likelihood ratio of 0 (95% CI, 0.0-2.5) suggests that a negative test will effectively rule out the presence of full-thickness tears of the subscapularis. A positive external rotation lag sign is the clinical test most likely to indicate that full-thickness tears of the supraspinatus and infraspinatus are present (specificity, 94%). However, the external rotation lag sign did demonstrate a low sensitivity score of 46% and negative likelihood ratio of .57 (95% CI, 0.4-0.9), which means that a negative test will not rule out the presence of full-thickness tears.

Conclusions

The findings of this investigation suggest that a clinical diagnosis of a full-thickness tear of the rotator cuff cannot be conclusively reached using one or more of the lag signs.     

Can the dimensions of artificial tendon lesions be predicted ultrasonographically? A cadaveric study.

OBJECTIVE: To prove the reliable assessment of artificial partial tendon lesions in cadavers. METHODS: The tendon of the tibialis anterior muscle was cut twice (transversely, not standardized depths) along its dorsal surface. The dimensions were measured by using a 10-MHz linear probe and a gliding caliper. The lesions were classified as type A tears (<60%; n = 15) and type B tears (>60%; n = 28). RESULTS: The depths of type A tears had high correlation (r = 0.827), and those of type B tears had low correlation (r = 0.415). This low correlation was due to subtotal lesions (50%-70%; r = 0.699). High-resolution ultrasonography allowed the correct detection of 14 type A tears and 21 type B tears (kappa = 0.63; accuracy, 81%; type B tears: sensitivity, 75%; specificity, 93%). CONCLUSIONS: High-resolution ultrasonography is able to assess the dimensions of artificial partial tendon lesions in cadavers and would be an accurate tool for determining the lesion percentages in patients with partial tendon tears.     

Conservative management of full-thickness rotator cuff tears. A prospective study of 24 patients]

OBJECTIVE: To evaluate the efficacy of conservative treatment of full-thickness rotator cuff tears. METHOD: A prospective open study of patients with full-thickness rotator cuff tears. The diagnosis was confirmed by ultrasonography examination. Therapeutic efficacy was evaluated before treatment, at the end of the treatment, and at 1, 3 and 6 months. Pain and handicap intensity were measured by a visual analogue scale, by the algo-functional Constant score, by articular mobility and, finally, by the resumption of daily and/or professional activities. Successful treatment was considered with a VAS pain scoreor=80. RESULTS: Twenty-four patients, mean age 59 years, with full-thickness rotator cuff tears for 9 months, on average, were included in the study. The parameters of pain function and handicap improved significantly since the end of treatment. The Constant score improved greatly, from 44.8 before treatment to 71.8 at the end of treatment and 74.2 at 6 months. This improvement continued until 3 months after treatment. The rate of success was 75% at 6 months. CONCLUSION: Despite the small sample size, our study confirm that rehabilitation should always be performed before a decision of surgical repair.     

实时超声检查与磁共振成像诊断冈上肌腱撕裂的对比研究

目的评价实时超声检查与磁共振成像(MRI)对冈上肌腱撕裂病变的诊断价值。方法回顾性分析2003年1月至2008年1月间经手术证实冈上肌腱撕裂且临床资料完整的70例患者的实时超声检查及MRI检查资料,以开放手术或肩关节镜术中结果作为金标准,比较两种检查方法的有效性。结果 70例冈上肌腱撕裂,术前实时超声检查诊断65例,MRI诊断67例。实时超声检查诊断冈上肌腱撕裂的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为92.8%、82.1%、92.8%、82.1%及89.8%。MRI诊断冈上肌腱撕裂的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.7%、85.7%、94.4%、88.9%及92.9%。经χ2检验,冈上肌腱撕裂实时超声检查的有效性与MRI检查的有效性无统计学差异(χ2=0.09,P0.05)。结论实时超声检查与MRI同样能够准确地诊断冈上肌腱撕裂,可作为冈上肌腱检查的首选影像学方法 。