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Query: UMLS:C0851184 (thinning)
 11,252 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After briefly reviewing the shoulder impingement syndrome, the authors investigate the role of two diagnostic imaging methods, i.e., ultrasonography (US) and arthrography, in demonstrating the typical features of this condition. Over a 15 months' period, 190 patients suffering from shoulder pain were examined with arthrography; 50 of them subsequently underwent acromion plastic surgery and rotator cuff stitching. This study was aimed at comparing US and arthrographic results, applying classifiable criteria to make the most accurate diagnosis of rotator cuff tears. The lack of visibility of the rotator cuff at US was the major and clearest sign of tear (100% of cases). The association between cuff thinning and hypo/hyperechoic damaged focal areas was another major sign (in 76.19% of complete tears and in 14.28% of incomplete tears). Hyperechoic focal areas alone proved to be a false-positive finding in 5 cases, while in 11 of 19 cases normal US patterns were a false-negative finding; in 3 cases other conditions were diagnosed. To conclude, the value of US is emphasized in the screening of the painful shoulder and the use of arthrography is suggested when both clinical tests and US fail to yield enough information for a diagnosis to be made.
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PMID:[Rotator cuff rupture in the shoulder impingement syndrome. Echography and arthrography: 2 diagnostic methods compared]. 782 69

Based on a retrospective study of 179 MRI records covering four populations (patients presenting with impingement without known injury (n = 90), post-traumatic shoulder pain (n = 28), instability or dislocation (n = 36) and controls (n = 25)), morphologic criteria are suggested to define presumedly normal arches and arches compatible with subacromial impingement. The subacromial arch is presumed normal or without impingement if the sagittal and frontal views show it to be parallel to the humeral head, and/or if there is a fatty layer interposed between the arch and the supraspinatus m. The arch is presumed "aggressive" or actually capable of giving rise to impingement if, in either the sagittal or frontal view, there is a zone of narrowing of the subacromial passage with an impression of the arch on the supraspinatus tendon or tendinous thinning at this level or just lateral to this narrowed zone. Based on these criteria, study of the 179 MRI records demonstrated a significant difference of distribution of the arches in the four populations. "Aggressive" arches were found in 45.5% of patients with impingement, 25% of patients with posttraumatic pain, 8.9% of patients with an acute or recurrent dislocation and 12% of controls. Conversely, a presumedly normal arch was found in 56% of the controls, 55% of patients with dislocation, 25% of posttraumatic painful shoulders and only 5.5% of patients with clinical impingement. Subacromial impingement may be due to the type 3 acromial dysplasia described by Bigliani or to a thickening of the coracoacromial ligament at its acromial attachment. This study was supplemented by 15 anatomic dissections which confirmed the regularity of attachment of the coracoacromial ligament at the inferior aspect of the acromion along its lateral border.
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PMID:Anatomy of the acromial arch: correlation of anatomy and magnetic resonance imaging. 848 37

An experimental study was performed on cadaveric joint specimens of the shoulder to determine the accuracy of US and MRI in diagnosis of abnormalities of the rotator cuff. The value of different morphological criteria was evaluated for discrimination of degeneration as well as partial and complete disruption. A total of 38 surgically exposed specimens of the shoulder joint were examined by US, MRI and pathological methods visualising the tendons of the rotator cuff in same axial and longitudinal orientations. The three imaging modalities were reviewed separately by experienced examiners, respectively, who were blind to other results. Evaluation criteria consisted of signs of shape (thinning, thickening, discontinuity and absence of rotator cuff) and structure (changes in echogenicity in US, increased signal intensity in MRI, tissue changes in pathology). Findings in US and MRI were finally compared with pathology to assess sensitivity and specificity. Pathology demonstrated 4 full-thickness tears, 6 partial-thickness tears, 16 cases with degeneration and 12 normal rotator cuffs. Ultrasound showed pathological signs in all abnormal cuffs, and one MRI report was false negative. Specificity was 67 % in US (4 of 12 cases were false positive) and 100 % in MRI (no abnormal findings in healthy tendons). Discrimination of different pathological disorders of the rotator cuff was reduced in both methods. Using US only 10 of 16 cases of degeneration, 2 of 6 partial tears and 3 of 4 complete tears were correctly defined. Using MRI 13 of 16 degenerations, 3 of 6 partial tears and 3 of 4 complete tears were detected. The MRI technique failed to visualise intratendinous calcifications in all 3 cases. We conclude that MRI and US are both sensitive in detection of abnormalities of the rotator cuff. Ultrasound should be the primary diagnostic method in screening of shoulder pain because it is economic and fast. The MRI technique should be used secondary because it provides more information about extent of tendons and has lower risk of artefacts.
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PMID:Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens. 903 13

The wide spectrum of shoulder instability is difficult to include in 1 classification. The distinction between traumatic, unidirectional, and atraumatic multidirectional instability is still widely used, even though this classification is not sufficiently precise to include all the different pathological findings of shoulder instability. We present "minor instability," which is a pathological condition causing a dysfunction of the glenohumeral articulation, especially in combination with microtrauma, repetitive or not, or after a period of immobilization or inactivity. When "minor shoulder instability" is suspected, the patient's history and detailed clinical examination represent the most important factors when establishing the diagnosis. In particular, the apprehension test stressing the middle glenohumeral ligament (MGHL)/labral complex in the position of midabduction and external rotation may be painful and may even reveal anterior instability or subluxation. Conventional radiographs are negative in most cases, as is magnetic resonance imaging arthrography. It is only after an accurate arthroscopic assessment that the pathological lesion can be found. The major pathological process can be identified at the level of the anterior superior labrum, in particular the MGHL complex, and appears as hyperemia, fraying, stretching, loosening, thinning, hypoplasia, or even absence. It may, however, be difficult to distinguish between a normal variant and a pathological lesion. Clinical symptoms and examination should always be correlated with arthroscopic findings. Recommended treatment is to restore shoulder stability and thereby prevent shoulder pain secondary to the increase in laxity. A reduction in range of motion should be expected during the postoperative phase, at least up to six to nine months. External rotation is usually permanently reduced by a few degrees.
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PMID:Minor shoulder instability. 1727 30

The sonographic presentation of intramedullary bone tumors is rarely reported. A patient with right shoulder pain for 7 months was clinically diagnosed with shoulder impingement syndrome. Sonographic examination revealed a segment of thinning cortex with a large, heteroechoic tumor deep in the greater tuberosity of the humerus. Increased peripheral vascularity of the tumor was observed in the power Doppler mode. The definite diagnosis was a giant cell tumor, whose sonographic findings are discussed.
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PMID:Sonographic appearance of a giant cell tumor of the humerus. 2148 Feb 92

A 14-year-old girl who presented with an endodermal cyst manifesting as severe neck and shoulder pain along with vesicorectal disturbances. Cervical magnetic resonance imaging showed a slightly enhanced intradural cyst at the C6-7 level in the ventral side of the spinal canal, with significant dorsal shortening and thinning of the spinal cord. Anterior corpectomy was chosen because of the dorsal effacement of the spinal cord. The cyst wall was subtotally removed to avoid damage to the normal spinal cord. After cyst removal, the iliac bone and an anterior cervical plate were used for anterior fusion. Postoperatively, her pain subsided without neurological deficits. The histological diagnosis was endodermal cyst. The cyst did not recur during a follow-up period of 18 months. Endodermal cysts are rare congenital lesions of the spine lined by endodermal epithelium. The natural history of this lesion is unclear, and the surgical strategy for the approach route and the extent of removal of the cyst wall remain controversial. We suggest that the anterior approach may allow a safer and more effective surgical route for the treatment of ventrally located endodermal cyst compared to the posterior approach.
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PMID:Ventral intradural endodermal cyst in the cervical spine treated with anterior corpectomy--case report. 2219 13