ULTRASOUND DIAGNOSIS OF SUBACROMIAL FIBROSIS IN PATIENTS WITH ROTATOR CUFF IMPINGEMENT SYNDROME

Abstract

Rotator cuff impingement syndrome (SURM) of the shoulder is considered one of the most common causes of pain in the shoulder joint in people of working age, mostly males. Due to the absence of characteristic signs of this pathology of the shoulder joint at the initial stage of the disease, fibrotic changes in the subacromial space (FI SAP) are detected late. The aim of the study was to evaluate the effectiveness of ultrasound navigation in the diagnosis and verification of fibrous changes in the subacromial space in patients with rotator cuff entrapment syndrome. Materials and methods. An analysis was made of 86 patients with cuff impingement syndrome, in whom fibrotic changes in the subacromial space are was initially detected according to ultrasound data. In group N1 (n1 = 42), the study data were analyzed without a minimally invasive intra-articular treatment procedure at the stage of conservative treatment, and in group N2 (n2 = 44) – with ultrasonic navigation of the subacromial space during a minimally invasive intra-articular treatment procedure. The comparison group (N3; n3 = 25) represented individuals without shoulder joint pathology. All patients underwent an ultrasound examination of the shoulder joint (Philips Sparq ultrasound scanner, linear high-density multifrequency transducer 5–13 MHz). Verification of the results of ultrasound of the shoulder joint is confirmed by the data of other methods of radiation imaging. Results. Ultrasound examination of the shoulder joint using dynamic functional tests before the start of therapeutic manipulations in patients with fibrotic changes in the subacromial space (in groups N1 and N2) visualization of the thickening of the supraspinatus tendon in combination with a decrease in the thickness of the subacromial space correlated with limitation of movement of the upper limb in the shoulder joint (p < 0,001). Comparative results in the study groups showed that the use of ultrasound diagnostics and navigation technologies during a minimally invasive intra-articular treatment procedure for fibrotic changes in the subacromial space provides an improvement in clinical manifestations. Conclusions. The possibility of ultrasonic visualization of the supacromial space in normal conditions without pathological changes in the shoulder joint and with fibrous changes in the subacromial space allows us to recommend the proposed method of ultrasound examination of the shoulder joint to be included in the treatment and diagnostic algorithm for the syndrome of incarceration of the rotator cuff of the shoulder. Ultrasound navigation as an effective method for diagnosing and verifying subacromial fibrosis in patients with rotator cuff entrapment syndrome.