Dynamic ultrasound used to evaluate coracoacromial ligament displacement during passive motions in post-stroke patients with hemiplegic shoulders
WU Chiqiu1, YU Dan2, FAN Jingguo3, SHENG Guoli4
1. Outpatient Department; 2. Department of Medical Imaging; 3. The Second Department of Internal Medicine; 4. Medical Department, Zhejiang Provincial Corps Hospital, Chinese People's Armed Police Force, Hangzhou 310051, China
Abstract：Objective To explore the ultrasonographic characteristics of hemiplegic shoulders and evaluate coracoacromial ligament displacement during passive motions with dynamic ultrasound. Methods A total of 31 patients who suffered from post-stroke hemiplegic shoulders for the first time underwent dynamic ultrasound examinations. The vertical displacement of the coracoacromial ligament was analyzed by the motion tracing program during the following passive assisted motions: forward flexion in the scapular plane, horizontal abduction in the axial plane,external rotation with the arm at 0° abduction , internal rotation with the arm at 0° abduction, internal rotation with the arm at 90° abduction, and internal rotation at the back. Results ①Twenty-eight cases(90.32%) of abnormal ultrasound results were found among these patients. The findings of ultrasound disclosed 22 cases of lesions of the long head of the biceps tendon and tendon sheath,1 case of dislocation of the long head tendon,13 cases of bursitis and bursa effusion,15 cases of rotator cuff injury, and 18 cases of shoulder subluxasion. Multiple lesions existed simultaneously in 23 cases. There was significant difference in the incidence of the disease compared to the contralateral shoulders (P<0.01).②The mean vertical displacement of the coracoacromial ligament during passive assisted motions was significantly different between hemiplegic shoulders and contralateral shoulders(P<0.01).At the same time,the mean vertical displacement of the coracoacromial ligament during forward flexion, horizontal abduction, internal rotation with the arm at 90° abduction, and internal rotation at the back was significantly different compared to external rotation with the arm at 0° abduction and internal rotation with the arm at 0° abduction(P<0.01). Conclusions Dynamic ultrasound can disclose lesions of the post-stroke hemiplegic shoulder and help observe the variations of vertical displacement of the coracoacromial ligament during passive assisted motions. It is recommended that patients avoid shoulder motions which are likely to cause subacromial impingement.
Park J, Chai J W, Kim D H,et al. Dynamic ultrasonography of the shoulder[J]. Ultrasonography,2018,37(3):190-199.
[2]
王金锐,刘吉斌. 肌肉骨骼系统超声影像学[M].北京:科学技术出版社,2007:21-45.
[3]
Benlidayi C,Basaran S. Hemiplegic shoulder pain:a common consequence of stroke[J]. Pract Neurol,2014,14(2): 88-91.
[4]
Pong Y P,Wang L Y,Wang L,et al. Sonography and physical findings in stroke patients with hemiplegic shoulders: a longitudinal study[J]. J Rehabil Med, 2012, 44(7): 553-557.
Rockwood C A, Matsen F A,Wirth M A,et al. 肩关节外科学[M]. 4版. 徐卫东,陈世益,李国平, 等译. 北京:人民军医出版社,2012:649-650.
[7]
Yamamoto N,Muraki T,Sperling J W, et al. Contact between the coracoacromial arch and the rotator cuff tendons in nonpathologic situations: a cadaveric study [J]. Shoulder Elbow Surg,2010,19(68): 1-7.
[8]
Wu C H, Chang K V, Su P H,et al. Dynamic ultrasonography to evaluate coracoacromial ligament displacement during motion in shoulders with supraspinatus tendon tears[J]. J Orthop Res,2012,30(9):1430-1434.
[9]
Park J, Chai J W, Kim D H,et al. Which shoulder motions cause subacromial impingement? Evaluating the vertical displacement and peak strain of the coracoacromial ligament by ultrasound speckle tracking imaging[J]. Shoulder Elbowl Surg, 2015, 24(11):1801-1808.
[10]
Chopp J N,O'Neill J M, Hurley K,et al. Superior humeral head migration occurs after a protocol designed to fatigue the rotator cuff: a radiographic analysis[J]. J Shoulder Elbow Surg, 2010,19(8):1137-1144.
[11]
Kanatli U, Ayanoglu T, Aktas E,et al. Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear[J]. Shoulder Elbowl Surg, 2016, 25(2):1824-1828.
2020, Vol. 31 
