Up to 30% of the adult population suffers from impingement syndrome with severe pain. Detection of the disease in the early stages is difficult. Early diagnosis of the initial signs of degenerative changes in the subacromial space saves the patient from surgery and additional risk of postoperative complications. The aim of the study is to evaluate the informative value of radiation methods for diagnosing subacromial impingement syndrome based on the analysis of papers published by domestic and foreign authors, depending on etiopathogenetic factors and anatomical structure of the shoulder joint. Materials and methods. The authors analyzed Russian and foreign publications on anatomical, etiological, pathogenetic, clinical, diagnostic features of subacromial conflict syndrome from databases: e-library (https://www.elibrary.ru), Oxford Medicine Online (https://academic.oup.com /), PubMed (https://pubmed.ncbi.nlm.nih.gov/) and others. The applied research methods were analysis and synthesis, axiomatic method and abstraction. Results. The development of subacromial impingement syndrome was revealed to be due to the structural features of the shoulder joint, which differs from other joints in anatomical and functional complexity. At this, changes in the rotator cuff of the shoulder joint develop under the influence of various etiopathogenetic factors, which can be both external (a decrease in subacromial space, an increase in the volume of the coracoacromial arch, instability, overload of the shoulder joint) and internal (changes in vascularization, pathology of collagen fibers' microstructure, degeneration of the tendons in the rotator cuff, etc.) Currently there is no unified approach to the algorithm of radiation diagnosing the early signs of impingement syndrome and injuries to the rotator cuff of the shoulder joint. Although radiography is a simple and informative method to assess the condition of the shoulder joint, its sensitivity at an early stage of impingement syndrome is insufficient. Magnetic resonance imaging is highly informative and sensitive in the diagnosis of injuries to the rotator cuff of the shoulder joint, however, it has a number of limitations, such as the presence of some contraindications, its high cost, protracted examination time, etc. Ultrasound examination is currently considered the preferred method in the diagnosis of impingement syndrome due to its high informative value, speed of execution and the possibility of its repeatability. Conclusions. The analysis of the informative value of radiation diagnostics methods showed that in identifying the early signs of subacromial impingement syndrome, taking into account etiopathogenetic factors and the anatomical structure of the shoulder joint, the ultrasound method is optimal and preferable; for more complex and controversial cases, according to certain indications, they are the methods of X-ray computer and magnetic resonance imaging. In the absence of the possibility of using high-tech diagnostic methods, classical radiography of the shoulder joint is performed.
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.
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