Abstract
Painful shoulder disorders have pain and restriction of mobility as the principal symptoms, and almost all of them occur from regressive degeneration. The differences in the main symptoms and the response to treatment depend on the degree of this degeneration. Therefore, it is important for treatment that the nature and site of these pathological lesions be as accurately defined as possible. The author considered that in the case of painful shoulder disorders, knowledge of both the rotator cuff, especially the bursal surface of the supraspinatus tendon, and the subacromial bursal region was indispensable, and that the clinical examinations should be approached from the subacromial side. Thus subacromial bursography and subacromial bursoscopy were adopted. The purpose of this report is to assess the clinical effectiveness of these methods and to discuss the etiopathogenesis of painful shoulder disorders.
Subacromial bursography was performed on 138 joints. An unevenness of the surface on the supraspinatus tendon, a decrease of bursal capacity, and irregular linear shadows in the bursal space could be found.
Subacromial bursoscopy was done on 51 joints. The main changes which could be observed with a bursoscope were, as in the case with the supraspinatus tendon, irregularity and fibrillation of the tendon surface and isolation and exfoliation of the tendon fibers, and in the synovial bursa, plica formations on the upper wall and funicular substances between the upper and lower walls. The author judged the distinct isolation and exfoliation of the tendon fibers to be a partial tear of the supraspinatus tendon. It should be remarked that partial tears were observed in over 40% of the cases already diagnosed as periarthritis.
It was concluded from the results of clinical examinations that the primary pathological focus of painful shoulder disorders should first take be on the bursal side of the rotator cuff. Subacromial bursography and bursoscopy are considered to be the only methods for early detections of pathologies and are very effective and essential examinations for painful shoulder disorders.
