肩関節不安定症と肩峰下インピンジメントの症状を呈した三角筋下脂肪腫の１例

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Subdeltoid lipomas are not uncommon and usually asymptomatic. We presented an unusual case of subdeltoid lipoma associated with symptoms of glenohumeral instability and subacromial impingement. A 38-year-old man complained of a feeling of snapping or propping accompanied by dull pain at his left shoulder. External rotation with contraction of the deltoid or active abduction of the shoulder could produce dull pain like a subacromial impingement. MRIs revealed large subdeltoid mass and also showed a high intensity lesion beneath the acromion that indicated inflammation of the subacromial space. Mass was extirpated using the wide delto-pectoral approach.Deep soft-tissue lipomas most frequently occured in patients 30-60 years old. Associated clinical symptoms were uncommon but included local pain, tenderness, limitation of range of motion, and nerve compression. Concerning the shoulder, the report of Rohrbough & Jobe was the only one that presented the clinical symptom of glenohumeral instability, and also Relwanis report was the only one that presented impingement syndrome caused by the lipoma. We had a case of subdeltoid lipoma associated with the symptoms of glenohumeral instability and subacromial impingement. To our knowledge this case was the 1st such reported. The middle 1/3 of the deltoid is a multipinnate muscle that is heavily collagenated. In our case, the sensation of instability would be produced by lipoma sliding forward beneath this thick intermediate deltoid muscle when it contracted with external rotation. And impingement would be produced by lipoma being pushed upward and compressing the subacromial bursa into the subacromial space. Subdeltoid lipoma, although extremely rare, could cause symptoms of glenohumeral instability and/or subacromial impingement. MRI was very useful to identify lipomas, but they have possibilities to be overlooked. MRI should be read by not only radiologist but also surgeons who know the patients clinical appearances well.
日本肩関節学会の論文

肩関節不安定症と肩峰下インピンジメントの症状を呈した三角筋下脂肪腫の１例

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