UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

肩部疼痛的影像学评估

Authors
Shahla Modarresi, MD
Cecilia Matilda Jude, MD
Section Editors
Robert H Shmerling, MD
Karl B Fields, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
何杰, 主任医师，教授

引言

肩部是活动度最大、最不稳定的关节，由于其复杂的解剖结构和生理功能，需要根据不同的临床状况选择合适的影像学检查。本专题将讨论多种影像学检查方法以及针对不同临床状况选择恰当影像学方法的推荐意见。病史和体格检查对在选择影像学检查方法前做出鉴别诊断非常必要，相关内容参见其他专题。 (参见“肩痛患者的评估”)

用于评价骨与关节疼痛的影像学检查方法的一般概述，包括其应用的物理学原理参见其他专题。 (参见“关节疼痛的影像学评估”)

影像学方法

目前有多种适用于不同情况的影像学方法可用。这些方法列于表中(表 1)，并将在下文作更详细的讨论：

普通X线摄影 — 普通X线摄影是几乎所有肩部病变的首选影像学方法。对于肩部急性创伤、钙化性肌腱炎、关节炎及锁骨远端骨质溶解(运动员中)的评估，X线摄影通常是唯一需要的影像学检查[1]。

计算机断层扫描 — 计算机断层扫描(computerized tomography, CT)通常仅用于评估骨折/骨折-脱位或人工肩关节。CT可以显示骨折的复杂性、移位和成角情况。CT可显示轴位、矢状位和冠状位的图像，并能以三维形式重建，有助于解读病情和术前计划[2]。

                                                               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-11-14.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Willick SE, Sanders RK. Radiologic evaluation of the shoulder girdle. Phys Med Rehabil Clin N Am 2004; 15:373.
  2. Haapamaki VV, Kiuru MJ, Koskinen SK. Multidetector CT in shoulder fractures. Emerg Radiol 2004; 11:89.
  3. Khan AA, Mowla A, Shakoor MA, Rahman MR. Arthrographic distension of the shoulder joint in the management of frozen shoulder. Mymensingh Med J 2005; 14:67.
  4. Steinbach LS, Palmer WE, Schweitzer ME. Special focus session. MR arthrography. Radiographics 2002; 22:1223.
  5. Fritz J, Fishman EK, Small KM, et al. MDCT arthrography of the shoulder with datasets of isotropic resolution: indications, technique, and applications. AJR Am J Roentgenol 2012; 198:635.
  6. Charousset C, Bellaïche L, Duranthon LD, Grimberg J. Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br 2005; 87:824.
  7. Bitzer M, Nasko M, Krackhardt T, et al. [Direct CT-arthrography versus direct MR-arthrography in chronic shoulder instability: comparison of modalities after the introduction of multidetector-CT technology]. Rofo 2004; 176:1770.
  8. Backhaus M, Burmester GR, Gerber T, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60:641.
  9. Kayser R, Hampf S, Pankow M, et al. [Validity of ultrasound examinations of disorders of the shoulder joint]. Ultraschall Med 2005; 26:291.
  10. Alasaarela E, Leppilahti J, Hakala M. Ultrasound and operative evaluation of arthritic shoulder joints. Ann Rheum Dis 1998; 57:357.
  11. Read JW, Perko M. Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg 1998; 7:264.
  12. Nazarian LN, Jacobson JA, Benson CB, et al. Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2013; 267:589.
  13. Farin PU, Jaroma H. Sonographic findings of rotator cuff calcifications. J Ultrasound Med 1995; 14:7.
  14. Azzoni R, Cabitza P, Parrini M. Sonographic evaluation of subacromial space. Ultrasonics 2004; 42:683.
  15. Sofka CM, Haddad ZK, Adler RS. Detection of muscle atrophy on routine sonography of the shoulder. J Ultrasound Med 2004; 23:1031.
  16. Aina R, Cardinal E, Bureau NJ, et al. Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique. Radiology 2001; 221:455.
  17. Galletti S, Magnani M, Rotini R, et al. The echo-guided treatment of calcific tendinitis of the shoulder. Chir Organi Mov 2004; 89:319.
  18. Naredo E, Cabero F, Beneyto P, et al. A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol 2004; 31:308.
  19. Westhoff B, Wild A, Werner A, et al. The value of ultrasound after shoulder arthroplasty. Skeletal Radiol 2002; 31:695.
  20. Middleton WD, Payne WT, Teefey SA, et al. Sonography and MRI of the shoulder: comparison of patient satisfaction. AJR Am J Roentgenol 2004; 183:1449.
  21. O'Connor PJ, Rankine J, Gibbon WW, et al. Interobserver variation in sonography of the painful shoulder. J Clin Ultrasound 2005; 33:53.
  22. Zehetgruber H, Lang T, Wurnig C. Distinction between supraspinatus, infraspinatus and subscapularis tendon tears with ultrasound in 332 surgically confirmed cases. Ultrasound Med Biol 2002; 28:711.
  23. Kluger R, Mayrhofer R, Kröner A, et al. Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters. J Shoulder Elbow Surg 2003; 12:110.
  24. Teefey SA, Middleton WD, Payne WT, Yamaguchi K. Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors. AJR Am J Roentgenol 2005; 184:1768.
  25. American College of Radiology. ACR Appropriateness Criteria. Expert Panel on Musculoskeletal Imaging. Shoulder Trauma 2010; 1.
  26. Handoll HH, Almaiyah MA, Rangan A. Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev 2004; :CD004325.
  27. Gumina S, Postacchini F. Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 1997; 79:540.
  28. Woodward TW, Best TM. The painful shoulder: part II. Acute and chronic disorders. Am Fam Physician 2000; 61:3291.
  29. Mancini GB, Malaspina C, Scalercio AM, Ferranti R. Anterior shoulder dislocation and injuries of the rotator cuff in patients aged over 40 years. Clinical and sonographic study. Chir Organi Mov 2001; 86:37.
  30. Sher JS, Uribe JW, Posada A, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995; 77:10.
  31. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 2009; 192:1701.
  32. Wright RW, Fritts HM, Tierney GS, Buss DD. MR imaging of the shoulder after an impingement test: how long to wait. AJR Am J Roentgenol 1998; 171:769.
  33. Seeger LL, Gold RH, Bassett LW, Ellman H. Shoulder impingement syndrome: MR findings in 53 shoulders. AJR Am J Roentgenol 1988; 150:343.
  34. Tasu JP, Miquel A, Rocher L, et al. MR evaluation of factors predicting the development of rotator cuff tears. J Comput Assist Tomogr 2001; 25:159.
  35. Farley TE, Neumann CH, Steinbach LS, Petersen SA. The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology. Skeletal Radiol 1994; 23:641.
  36. Chandnani V, Ho C, Gerharter J, et al. MR findings in asymptomatic shoulders: a blind analysis using symptomatic shoulders as controls. Clin Imaging 1992; 16:25.
  37. Liou JT, Wilson AJ, Totty WG, Brown JJ. The normal shoulder: common variations that simulate pathologic conditions at MR imaging. Radiology 1993; 186:435.
  38. Tuite MJ, Yandow DR, DeSmet AA, et al. Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging. Skeletal Radiol 1994; 23:541.
  39. Quinn SF, Sheley RC, Demlow TA, Szumowski J. Rotator cuff tendon tears: evaluation with fat-suppressed MR imaging with arthroscopic correlation in 100 patients. Radiology 1995; 195:497.
  40. Traughber PD, Goodwin TE. Shoulder MRI: arthroscopic correlation with emphasis on partial tears. J Comput Assist Tomogr 1992; 16:129.
  41. Sugihara T, Nakagawa T, Tsuchiya M, Ishizuki M. Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging. J Shoulder Elbow Surg 2003; 12:222.
  42. Thomazeau H, Boukobza E, Morcet N, et al. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 1997; :275.
  43. Farin PU, Jaroma H, Harju A, Soimakallio S. Shoulder impingement syndrome: sonographic evaluation. Radiology 1990; 176:845.
  44. Toyoda H, Ito Y, Tomo H, et al. Evaluation of rotator cuff tears with magnetic resonance arthrography. Clin Orthop Relat Res 2005; 439:109.
  45. Palmer WE, Brown JH, Rosenthal DI. Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology 1993; 188:683.
  46. Meister K, Thesing J, Montgomery WJ, et al. MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation. Skeletal Radiol 2004; 33:136.
  47. Roger B, Skaf A, Hooper AW, et al. Imaging findings in the dominant shoulder of throwing athletes: comparison of radiography, arthrography, CT arthrography, and MR arthrography with arthroscopic correlation. AJR Am J Roentgenol 1999; 172:1371.
  48. Modarresi S, Motamedi D, Jude CM. Superior labral anteroposterior lesions of the shoulder: part 2, mechanisms and classification. AJR Am J Roentgenol 2011; 197:604.
  49. Modarresi S, Motamedi D, Jude CM. Superior labral anteroposterior lesions of the shoulder: part 1, anatomy and anatomic variants. AJR Am J Roentgenol 2011; 197:596.
  50. Waldt S, Burkart A, Imhoff AB, et al. Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 2005; 237:578.
  51. Applegate GR, Hewitt M, Snyder SJ, et al. Chronic labral tears: value of magnetic resonance arthrography in evaluating the glenoid labrum and labral-bicipital complex. Arthroscopy 2004; 20:959.
  52. Cvitanic O, Tirman PF, Feller JF, et al. Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. AJR Am J Roentgenol 1997; 169:837.
  53. Tung GA, Entzian D, Green A, Brody JM. High-field and low-field MR imaging of superior glenoid labral tears and associated tendon injuries. AJR Am J Roentgenol 2000; 174:1107.
  54. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 1993; 161:1229.
  55. Gusmer PB, Potter HG, Schatz JA, et al. Labral injuries: accuracy of detection with unenhanced MR imaging of the shoulder. Radiology 1996; 200:519.
  56. Emig EW, Schweitzer ME, Karasick D, Lubowitz J. Adhesive capsulitis of the shoulder: MR diagnosis. AJR Am J Roentgenol 1995; 164:1457.
  57. Carrillon Y, Noel E, Fantino O, et al. Magnetic resonance imaging findings in idiopathic adhesive capsulitis of the shoulder. Rev Rhum Engl Ed 1999; 66:201.
  58. Kieft GJ, Dijkmans BA, Bloem JL, Kroon HM. Magnetic resonance imaging of the shoulder in patients with rheumatoid arthritis. Ann Rheum Dis 1990; 49:7.
  59. Boutin RD, Weissman BN. MR imaging of arthritides affecting the shoulder. Magn Reson Imaging Clin N Am 1997; 5:861.
  60. Alasaarela EM, Alasaarela EL. Ultrasound evaluation of painful rheumatoid shoulders. J Rheumatol 1994; 21:1642.
  61. Kaandorp CJ, Van Schaardenburg D, Krijnen P, et al. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 1995; 38:1819.
  62. Mnif J, Khannous M, Keskes H, et al. [Ultrasonography in the diagnostic approach of septic arthritis]. Rev Chir Orthop Reparatrice Appar Mot 1997; 83:148.
  63. Dubost JJ, Soubrier M, Sauvezie B. Pyogenic arthritis in adults. Joint Bone Spine 2000; 67:11.
  64. Graif M, Schweitzer ME, Deely D, Matteucci T. The septic versus nonseptic inflamed joint: MRI characteristics. Skeletal Radiol 1999; 28:616.
  65. Imhof H, Breitenseher M, Trattnig S, et al. Imaging of avascular necrosis of bone. Eur Radiol 1997; 7:180.
  66. Rand T, Trattnig S, Breitenseher M, et al. The postoperative shoulder. Top Magn Reson Imaging 1999; 10:203.
  67. Mohana-Borges AV, Chung CB, Resnick D. MR imaging and MR arthrography of the postoperative shoulder: spectrum of normal and abnormal findings. Radiographics 2004; 24:69.
  68. Feldman F. Radiology of shoulder prostheses. Semin Musculoskelet Radiol 2006; 10:5.
  69. Gemmel F, Van den Wyngaert H, Love C, et al. Prosthetic joint infections: radionuclide state-of-the-art imaging. Eur J Nucl Med Mol Imaging 2012; 39:892.
Topic Outline