《冈上肌出口位》-精品课件（公开).pptVIP

Supraspinatus outlet view and supraspinatus tendon tear 早读片 胡娟 2011-02-24 Type of acromion Type I has a flat undersurface and no relationship to impingement(4.6%). Type II acromion is characterized by a curved undersurface(81.3%). type III acromion has an anterior hook (hooked acromion)(14.1%). A fourth type of acromion shape was added that has a convex undersurface Bigliani et al. (1986) found a type III acromion in 70% of cadavers with rotator cuff tears, whereas only 3% of type I acromion were associated with a tear. Bursal-side partial tears or full-thickness tears of the rotator cuff are always associated with severe degenerative changes in the acromion, but degenerative changes in the undersurface of the acromion can be present when the rotator cuff is normal Clinical findings Approximately 40% of asymptomatic patients over 50 years old have full thickness rotator cuff tears The prevalence of partial- and full-thickness tears in symptomatic patients over 60 years old is greater than 60% Chronic causes such as repetitive microtrauma, subacromial impingement, tendon degeneration, and hypovascularity are thought to be responsible for most tears and account for this age-dependent prevalence. Acute macrotrauma is less frequently responsible for tears Clinical examination as a whole has a sensitivity 90% and a specificity of 54% in the detection of full-thickness rotator cuff tears. supraspinatus weakness weakness of external rotation impingement The supraspinatus muscle aids not only in stabilization of the shoulder joint but also in abduction of the arm. Clinical impingement syndrome is characterized by pain during use of the shoulder that is relieved by local subacromial anesthetic injection. Differential diagnosis Supraspinatus tendinosis calcific tendinitis subacromial subdeltoid bursitis greater tuberosity fracture adhesive capsulit