|ECR 2018 / C-2034|
|The technique and evaluation of dynamic shoulder MR imaging in subacromial impingement syndrome|
Shoulder pain affects approximately a third of general population, particularly older individuals . Subacromial impingement syndrome (SIS) is the most prevalent clinical diagnosis in these patients and the syndrome is diagnosed in one-half of shoulder pain sufferers . SIS refers to the cluster of symptoms with typical presentation of pain in the lateral part of deltoid muscle with pain intensity increasing during functional movements, particularly during the elevation of the arm.
The pain in SIS is caused by the mechanical compression of the subacromial/subdeltoid bursa, rotator cuff tendons and the long head of biceps between the coracoacromial arch and the humerus. Various underlying factors and pathological changes can provoke the impingement of soft tissue structures during their passage under the coracoacromial arch, which is formed by lateral part of the acromion and the coracoacromial ligament. The factors are in general divided into extrinsic and intrinsic ones . The extrinsic ones include for example the shape of the acromion, changes in the acromio-clavicular joint or the coracoacromial ligament. The intrinsic factors relate to the acute or chronic changes in the tendons and the tightness of the posterior capsule. In addition, scapular dyskinesis and poor posture can contribute to the development of painful symptoms .
The diagnosis of the condition remains mainly a clinical one with impingement tests of Neer and Hawkins-Kennedy considered especially reliable . The imaging modalities of ultrasound and magnetic resonance (MR) help to assess the presence of the underlying factors and structural pathoanatomical changes in the area. The MR images provide valuable information regarding structural abnormalities in the osseous structures, articulations and soft tissues of the shoulder gridle, including the presence and the size of tendon tears. The structural MR images provide important information to guide treatment planning, but is the static evaluation of the shoulder.
The aim in the management of SIS patients is to reduce pain and to improve function. In the acute phase non-operative treatment plans include anti-inflammatory drugs and rest. In cases of refractory and persistent shoulder pain, subacromial steroid injections and/or physical therapy with exercise programs are considered. Around 70% of patients with SIS have good outcome with conservative management only . Operative treatments, such as acromioplasty and debridement of tears, are considered for patients without traumatic and full-thickness rotator cuff tears, who show no improvement with conservative management after at least 3 to 6 months.
Physiotherapy has been demonstrated effective in randomised controlled studies . However, all patients do not benefit from the conservative treatment. Predicting response and prognosis to the conservative treatment and/or specific physiotherapeutic approach is often difficult. Dynamic MR imaging during shoulder movement may provide additional information to characterise better the underlying functional alterations in the shoulder gridle and to guide in the choice of specific physiotherapeutic approach. Furthermore, it may expose subtle abnormal functional findings before structural changes would be visible. In advance to the scientific study, we report the procedure of DS-MR and the detected abnormal findings in subacromial space (SAS) during abduction movement in patients with SIS.
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