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1、肩关节冈上肌腱炎,肩关节武汉大学 武汉，、11111111武汉 肩关节肩关节,钙化性冈上肌腱炎（Calcified Supraspinatus Tendonitis）,1.CST is a kind of soft tissue lesions ( belongs to scapulohumeral periarthritis )2.Etiology：The repeated use of shoulder joint、Subacromial impingement 、Tendon degeneration、calcium deposition.strian or trauma degener
2、ation calcium deposition 3.Symptom：swell and pain,CST is more commonly seen in women tendinitis of supraspinatus muscle and CST account for 21.5% in shoulder periarthriti. 1.颗粒小-未刺激到肩峰下滑囊无症状 2.颗粒大-接触到肩峰下滑囊-外展痛-亚急性发作 3.外伤或劳累-周围组织与滑囊炎症-急性发作 treatment：puncture-aspiration+ hormone therapy or surgical tr
3、eatment,imagemanifestations in early stage,X-RAY: soft tissue mass in greatertuberosit in homogeneousdensity MRI: low signalintensityonT1WI and high signal intensity on T2WI (bone destruction) may be misdiagnosedas osteoblastoma,Imagemanifestations in late stage,X-Ray : Calcification indifferentshap
4、es fluffy type : rough/along the long axis supraspinatus tendon long strip: edgestidy/along the long axis supraspinatus tendon sphere: edgestidy/around the long axis supraspinatus tendon,CST,the calcium deposit as hypointense signalwithin the supraspinatus tendon (arrow),肩周炎（Periarthrite Scapulohume
5、rale）,定义：肩关节囊及其周围韧带、肌腱和滑囊的慢性特异性炎症，又称“凝肩综合征”、“粘连性肩关节炎”、“五十肩”等;好发年龄及人群：50岁左右，女性多于男性；文献报道：右侧发病高于左侧；注意：肩周炎并非某一点的独立疾病，而是与肩关节周围病变（如滑囊炎，肌腱炎、钙化、撕裂的等）有密切联系，继而引起肩周软组织广泛粘连，肩关节活动障碍;病理 肩关节囊与滑膜隐窝的无菌炎症：充血、水肿、炎细胞浸润； 肩部周围肌肉、韧带、深筋膜的慢性劳损（可伴出血）；,Classification of Shoulder Portion Disorders,引起慢性肩痛与活动受限的肩周疾病 (Shoulder di
6、sorders with chronic shoulder pain and shoulder joint activity limits) 1.肱二头肌长头肌腱鞘炎(myotenositis of long head of biceps brachii ) 2. CST； 3. 肩峰撞击综合征:肩峰下滑囊炎/肩袖撕裂 (Subacromial Impingement Syndrome: subacromial bursitis/rotator cuff tear) 4.盂唇-韧带复合体损伤(glenoidal labrum-Ligament complex injury) 5. 冻结肩(粘连
7、性关节囊炎)：Frozen Shoulder(adhesive capsulitis ),肱二头肌长头肌肌腱炎（ tendinitisof long headofbiceps brachiimuscle ）,1 degeneration and tear Etiology： impingemententraped repeatedly-degeneration -tear Image Manifestations degeneration：thickening/increased signal on tendon partial rotator cuff tear:Interruption/t
8、hickening、high-signal on T2 full tear：Interruption/ feeling of empty in intertubercular sulcus 2 dislocation and subluxation Etiology： dysontogenesis (medial wall of intertubercular sulcus) tendon lacerations of Subscapular Muscle Tendon image manifestations tendon displacement(can be shifed in subs
9、capular muscle) feeling of empty in intertubercular sulcus,Normal and tendinitis of the long head of the biccps 21A:normal 21B: MR image shows the enlargement of the tendon (arrow) and abnormal internal high signal intensity,Partial tear of the long head of the biceps. （MR arthrographic images show
10、the abnormal enter of the contrast material into the substance of the tendon (arrows), which represents a partial tear.）,full tear,Dislocation of the long head of the biceps. Delamination-type tear of the subscapularis,肩关节撞击综合征(Impingement Syndrome of the Shoulder),定义(Definition) 喙肩弓与肱骨头之间的空间绝对或相对减小
11、，使肩部在上举外展过程中，喙肩弓与肱骨头反复卡压其间的软组织结构主要为肩峰下滑囊(Subacromial bursa )、冈上肌腱(supraspinatus tendon)和部分冈下肌腱 (lower-scapular tendon) 、肱二头肌长头腱( long head of bicep tendon)引起症状，称为肩峰下撞击综合征。,Subdeltoidsubacromial bursitis,Subdeltoidsubacromial bursitis.,Acromial morphology,Tendinitis,Full thickness tear of the suprasp
12、inatus.,the supraspinatus tendon becomes thicker, with abnormal high signal as intense as fluid extending from the articular surface to the subacromial bursa surface(arrow).,Full thickness tear of the supraspinatus,retraction of the tendon,Full thickness tear of the subscapularis,partial thickness t
13、ear of the subscapularis,盂唇韧带复合体损伤（the labral-ligamentous complex injury） : Inculding Bankart lesiom and Osseous Bankart lesion,major components:glenoidal labrum/ long head of bicep tendon/ glenohumeral ligament Classification Throwers SLAP injury:11-1 O commonly involved the long head of bicep tend
14、on Labrum injury/ tendon lacerations syndesmodiastasis(glenoidal labrum) Bankeart lesion:1-6 O Periosteal tear (85%-95%) shoulder dislocations Reverse Bankert lesion(6-11O）:posterior displacement of humeral head,labral tear,Classical Bankeart Lesion,盂唇韧带复合体损伤（ torn antteroinferior labrum ） : Inculding Bankart lesiom and Osseous Bankart lesion,labral tear(Periosteal tear),
