The Application Of Ultrasound In The Diagnosis And Treatment Of Subacromion Impingement Syndrome

Objective: To investigate the ultrasonographic characteristics of Subacromion Impingement Syndrome(SIS)and evaluate the clinical value of ultrasound-guided interventional therapy for SIS.Methods: The ultrasonic examination of bilateral shoulder joint were performed for 20 normal volunteers and 123 patients with SIS,while shoulder joint MRI examination was underwent among 63 patients with SIS at the same time.The echo of Long Head of Biceps Brachii(LHBB)and its tendon sheath,rotator cuff tendons and Subacromial Bursa(SAB)were observed.The thickness of them were measured for bilateral comparison.The ultrasonographic features of SIS in different periods were summed up and the stage of ultrasound diagnosis were performed.According to the stage of ultrasound diagnosis,different ultrasound guided interventional therapeutical schemes were selected.50 patients with SIS in stage I were treated with ultrasound-guided injection.60 patients with SIS in stage II and part of III were treated with ultrasound-guided injection combined with acupotomy.13 patients without the indication of ultrasound-guided interventional therapy were treated surgically.1 week,1 month,3 month and 6 month after treatment were flowed up.The VAS and CMS scores after treatment of 1 week,1 month,3 months and 6 months were compared with those before treatment and the previous period to evaluate the curative effect.Results:1.The echo and thickness of LHBB and its tendon sheath,rotator cuff tendon and SAB could be demonstrated by ultrasound.There was no significant difference in the thickness of bilateral LHBB and its tendon sheath,rotator cuff tendon and SAB.Moreover,the thickness of LHBB and its tendon sheath,rotator cuff tendon and SAB had no statistical difference with the standard reference of shoulder musculoskeletal ultrasound.2.compared and analyzed the MRI signs and ultrasound images in 63 cases of SIS.Ultrasonic images were consistent with the MRI signs in the thickening and effusion of the tendon sheath of LHBB,the thickening and effusion of SAB,the inflammation of the tendon and the rupture of the tendon,with kappa coefficients of 0.634,0.75,0.545,0.65,0.40 and 0.806 respectively.According to the pathological staging of Neer,the diagnostic staging of SIS ultrasound was put forward.Stage I: only thickening of SAB and / or tendon sheath of LHBB,hyper-echo,with or without effusion and generally no significant color blood flow signal.Stage II: rotator cuff tendons were swelling,thickening and hypo-echo,while color blood flow signal was rich in early phase;In the chronic stage,the normal tendon texture was disappeared;the echo of rotator cuff tendons was increased unevenly;there were small spots,mottled or massive strong echoes which followed by acoustic shadow;the blood supply was not abundant.Stage III: rotator cuff tendons were partly or completely tore.The partial tear was characterized by interrupted tendon echo and hypoechoic area was irregular without obvious blood flow signal.The complete tear showed that the normal tendon echo disappeared,which was full of hyperechoic tissue or synovia and a little blood flow signal could be seen inside.In this study,there were 14 cases of SIS stage I diagnosed by ultrasound.37 cases of SIS stage II were diagnosed by ultrasound,including 20 cases of rotator cuff tendinopathy,5 cases of chronic tendonitis and 12 cases of calcified tendinitis.12 cases of SIS stage III were diagnosed by ultrasound,with 11 cases of partial tear of tendon and 1 case of complete tear of tendon.3.The VAS scales were lower while the CMS scores were higher at 1 week,1 month,3 months and 6 months after both treatment,which had statistical difference(P<0.01).However,there was no significant difference between the score changes of the previous period.Conclusions:1.Ultrasound could demonstrate the anatomic structure of SIS.There were different ultrasonographic manifestations at different pathological stages of SIS,which was feasible for staging.2.Ultrasonographic staging of SIS could provide the objective basis for the selection of individualized treatment scheme in clinical practice,which could achieve accurate positioning and precise treatment and was of great significance clinically.