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Ultrasound of the shoulder joints with osteoarthritis
Medical expert of the article
Last reviewed: 28.11.2021
The shoulder joint is one of the most comfortable for ultrasound, especially because many pathological changes occur in its soft tissues. Because of the low information content of the X-ray method, reflection of soft-tissue changes was allowed by ultrasound along with MRT to become leading in the study of the shoulder joint.
Particular attention in the study should be given to the so-called rotator cuff, formed by the tendons of four muscles: supratemal, subacute, subscapular and small round. Mandatory projections are the assignment of the patient's arm to the external rotation position (for the investigation of the subscapular muscle) with passive internal and external rotation of the patient's limb, inserting the examined arm behind the back with transverse positioning of the sensor (for assessment of the tendon of the supraspinatus). In practice, ruptures of the rotator cuff often occur, which can be complete, partial, longitudinal and transverse.
It should be taken into account that it is not only traumatic injuries of this formation, but also that in individuals with osteoarthritis, especially the elderly, breaks often occur due to degenerative changes in the joint and its constituent elements, which result in protrusive tendonitis up to complete degenerative rupture of the rotator cuff of the shoulder. This can be accompanied by bursitis, not only in the podkarmialnoy, but also in a counterfeit bag. Most often, these changes are localized at the base of the tendon of the supraspinatus, subacute muscle and the large tubercle of the humerus.
All of these changes can lead to the development of so-called them pindzhement syndrome, characterized by persistent degenerative changes in the glenohumeral joint perikapsulyarnyh tissues and is often accompanied by severe pain, varying degrees of limitation of motion in a joint. The causes of the development of the impingement syndrome, along with osteoarthritis, are microtractic injuries of the capsule, shoulder injury, complicated by rupture of the rotator cuff, as well as diseases such as rheumatoid arthritis and diabetic arthropathy. There are three stages of the disease.
The first stage is edema and hemorrhage. Pain manifests itself after physical exertion, characterized by pain arising at night. At this stage, the symptom of the "arc" or "arches of painful leads" is determined, when when the patient's arm is withdrawn pain appears within 60-120 ° of active abduction. This indicates that there is a collision of a large tubercle of the humerus, the anterior anterior edge of the acromion and the coracoid-clavicular ligament. Between these structures, at the place where the rotational cuff is attached, its infringement occurs. When ultrasound in the articular bag there is an uneven thickening of the tendon of the supraspinatus, with the presence of hyperechoic areas of fibrosis. In the projection of the apex of the acromial process of the scapula, at the point of attachment of the tendon of the supraspinatus to the large tubercular humerus, its thickening and subacromial bursitis are noted.
The second stage is fibrosis and tendonitis. There are painful phenomena in the shoulder joint with complete absence of active movements. Degenerative changes occur in the tendon-muscle and ligamentous complex of the shoulder joint. As a result, the stabilizing function of the tendon apparatus decreases. When ultrasound is observed heterogeneity of the tendon structure of the supraspinatus, the appearance of multiple small hyperechoic inclusions. In the intercampis fossa, thickened, uneven contours of the long head of the biceps arm muscle with single point calcifications and effusions are visualized.
The third stage - rupture of the rotator cuff - is characterized by stable painful contracture with passive movements and almost complete loss of movements in the shoulder joint. The cavity of the shoulder joint significantly decreases in volume, the joint capsule becomes rigid and painful. In periarticular tissues, an adhesive capsulitis develops.