International Medical Journal, Vol. 23., Iss. 4, 2017, P. 87−91.
ULTRASONOGRAPHY OF MUSCULOSKELETAL AND CARTILAGINOUS PATHOLOGY IN THE SHOULDER JOINT REGION
Prof. M. I. Sytenko Institute of Spine and Joint Pathology, NAMS of Ukraine, Kharkiv, Ukraine
At present it is assumed that pain in the humeroscapular area is usually a symptom of polyethiological origin. The variety of etiological factors and structural and functional manifestations of the pathological changes in the tissues of the humeroscapular area with minor differences in pain symptoms create significant difficulties in diagnosis without the use of special instrumental methods of investigation. The purpose of our work was to evaluate the capabilities of ultrasound (US) in differential diagnostics of pathological changes in articular and paraarticular tissues in the region of the shoulder joints, to identify the most characteristic ultrasonographic signs for various nosological forms of pain syndrome in this localization, basing on the own data analysis of ultrasonographic examination of the patients with humeroscapular pain syndrome (HSPS). The study involved 189 patients aged 18−75 years with complaints of pain and impaired function of the shoulder joint. The investigation was performed on the Siemens G−50 and Toshiba Aplio−500 ultrasound systems using a standard procedure. The analysis of the obtained results allowed to distribute the examined patients among 7 groups according to the nosological characteristics and to identify the most peculiar ultrasonographic criteria observed in different forms of HSPS. Group 1 included the patients with radiologically diagnosed osteochondrosis of the cervical spine. Group 2 included 12 patients whose X−ray examination showed the signs of osteochondrosis in the thoracic region. Group 3 included 57 patients with ultrasonographically demonstrated signs of inflammatory processes in the paraarticular tissues; thickening of the tendons of supraspinatus, infraspinatus, subscapular muscles and the tendon of long head of the biceps brachii muscles; degenerative changes, as erosions of the acromioclavicular joint contour, inflammatory changes and acromioclavicular ligaments edema; limitations of motor activity. Group 4 included the patients with ultrasonographically displayed inflammatory changes in the structure of supraspinatus tendon. The tendon was thickened, its echogenicity was reduced, its structure was inhomogeneous. In the structure, hyperechoic inclusions of various sizes (calcinates) were visualized. Group 5 included the patients with ultrasonographically demonstrated structural changes only in the acromioclavicular joint typical for osteoarthritis of the acromioclavicular joint. Group 6 consisted of female persons with tenosynovitis of the tendon of long head of the biceps brachii, significant thickening of the joint capsule, and subacromial conflict at abduction. Group 7 included the patients with complaints of pain and limitation of active movements in the shoulder joint, associated with traumatic damages or significant loads. Ultrasonography allows differentiation of the situations when the pain in the shoulder region can be related to pathological changes in the structure of the articular and paraarticular tissues of the shoulder joint from situations when it is not associated with such local processes but has a «reflected» character due to dystrophy of the cervical or thoracic spine.
Key words: ultrasonography, shoulder joint, humeroscapular pain syndrome.