肩甲下筋腱断裂の術前 MRI における評価

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概要

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• <B>Background:</B> Subscapularis tendon (SSC) rupture is detected in about 40% of patients with rotator cuff rupture. But it is difficult to diagnose SSC rupture correctly. The purpose of this study is to evaluate the relationship of various observations on preoperative MRI to SSC rupture.<BR><B>Methods:</B> We retrospectively reviewed 48 consecutive shoulders that had arthroscopic operations performed in our hospital. MRI was performed up to 2 months before operation. SSC discontinuity, SLAP lesion, long head of biceps tendon (LHB) dislocation or subluxation, superior SSC recess fluid, and subcoracoid bursa effusion were examined. Fatty infiltration of SSC was also evaluated according to Goutallier's classification.<BR><B>Results:</B> Thirty seven shoulders had rotator cuff rupture, which included 8 shoulders with complete SSC rupture, and 10 with incomplete SSC rupture. SSC discontinuity, LHB lesion, Superior SSC recess fluid, and fatty infiltration of SSC were detected more significantly in the shoulders of the complete SSC rupture group. Superior SSC recess fluid was seen in 7 of 8 cases of complete rupture and in all cases in the incomplete SSC rupture group.<BR><B>Conclusion:</B> Significantly, SSC discontinuity had the highest sensitivity (87.5%), and specificity (97.5%), and is considered to be useful for screening for complete SSC tear. Superior SSC recess communicates with glenohumeral joint but does not communicate with the subcoracoid bursa. Moreover, the vast majority of SSC ruptures start on the articular and cephalad aspect of the tendon insertion. Given these anatomical findings, we should estimate the presence of incomplete (joint side) SSC rupture with the presence of superior SSC recess fluid.

著者

• 杉森 一仁

  富山大学医学部　整形外科

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