Shoulder girdle neoplasms mimicking frozen shoulder syndrome
Shoulder girdle neoplasms mimicking frozen shoulder syndrome
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DOI：
10.1016/s1058-2746(03)00092-2
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发表时间：
2003-09-01
影响因子：
3
通讯作者：
Rami, K
中科院分区：
文献类型：
--
作者：
Robinson, D;Halperin, N;Rami, K
肩关节疼痛和不动是一种多因素疾病，明显受疼痛抑制关节运动的影响。由于该综合征非常常见，许多患者在治疗前没有进行详细的影像学检查。这项研究比较了一系列的7例患者，其中肿瘤是肩关节僵硬的根本原因与一系列的50例原发性或继发性冻结肩。除了详细的病史外，还完成了臂、肩和手残疾（DASH）上肢结局数据收集问卷，并对所有病例进行了体格检查、X线摄影、超声检查和骨扫描。在肿瘤病例中，在我们的肌肉骨骼肿瘤诊所就诊的67例肩带肿瘤患者中，7例的主要症状是肩关节僵硬，无放射学异常。肿瘤包括骨样骨瘤、骨母细胞瘤、转移癌、软骨肉瘤、骨膜脂肪瘤和急性淋巴母细胞淋巴瘤。所有病例的诊断都是通过常规锝99亚甲基二膦酸盐骨扫描显示的局灶性同位素摄取区域确定的。在一例转移性结肠癌病例中，只能通过磁共振成像确定诊断，因为X线片正常，骨扫描显示肱骨近端弥漫性摄取。由潜在肿瘤引起的冻结肩的患者明显更年轻，并且在兰德简表-36健康调查中的疲劳/能量维度评分较低。最有用的诊断测试似乎是一个离散的区域的骨压痛，目前在7例肿瘤和50例对照组患者中只有5。虽然潜在的肿瘤是引起冻结肩综合征的罕见原因，但误诊的潜在格罗夫后果和进行不必要和无效的侵入性手术的可能性应促使医生提高警惕。对于光刺激引起的离散性骨压痛的患者，应安排骨扫描并考虑磁共振成像。
Shoulder pain and immobility comprise a multifactorial disorder apparently affected by pain inhibiting joint motion. As the syndrome is very common, many patients do not undergo detailed imaging studies before treatment. This study compared a series of 7 patients in whom a neoplasm was the underlying cause for the stiff shoulder with a series of 50 patients with primary or secondary frozen shoulder. In addition to a detailed history being taken, the Disabilities of the Arm, Shoulder, and Hand (DASH) upper limb outcomes data collection questionnaire was completed and physical examination, radiography, ultrasonography, and bone scanning were performed in all cases. In the cases of tumor, the presenting symptom was a stiff shoulder without radiographic abnormality in 7 of 67 patients with shoulder girdle neoplasms who were seen at our musculoskeletal oncology clinic. The tumors included osteoid osteoma, osteoblastoma, metastatic carcinoma, chondrosarcoma, periosteal lipoma, and acute lymphoblastic lymphoma. The diagnosis was established in all cases by an area of focal isotope uptake demonstrated by a routine technetium 99 methylene diphosphonate bone scan. In a single case of metastatic colon carcinoma, the diagnosis could only be established by magnetic resonance imaging, as the radiographs were normal and the bone scan demonstrated diffuse uptake over the proximal humerus. The patients whose frozen shoulder was caused by an underlying tumor were significantly younger and had a lower fatigue/energy dimension score on the RAND Short Form-36 health survey. The most useful diagnostic test appears to be a discrete area of bony tenderness, present in 7 of 7 patients with tumor and in only 5 of 50 patients in the control group. Although an underlying tumor is a rare cause of frozen shoulder syndrome, the potential grove consequences of misdiagnosis and the possibility of performing an unnecessary and ineffective invasive procedure should prompt physicians to increased vigilance. In patients with discrete bony tenderness elicited by light topping, a bone scan should be ordered and magnetic resonance imaging should be considered.