Abstract
After a brief comment on the biomechanics of the shoulder joint and especially of its periarticular tissues, focussing on the biomechanial and morphological investigations into the function of the coracoacromial ligament, the following subjects are developed: clinical sings and symptoms, the use of imaging techniques during the clinical workup and the treatment of the 5 states of disease of the tissues around the shoulder joint.
Strictly speaking the notion 'h umeroscapular periarthritis' comprises
1. the supraspinatus syndrome
2. the tendinosis calcarea (calcific deposits)
3. the ruptur of the rotator cuff
4. the bicipital tenosynovitis
5. the proper frozen shoulder
As we now have been able to confirm in far more than 2000 patients with periarticular diseases of the shoulder, the clinical signs and symptoms of the first three of the above states of diseases are similar. According to our experience symptoms (as pain during rest or exertion, preponderance of nocturnal pain, weakness, painful arc and occasionally pseudoparalysis) lack specifity. Only the spontaneously internally rotated posture of the bending arm and the drop-arm sign have been exclusively observed with ruptured rotator cuffs. In addition the elicited symptoms (by Neer's Jobes'or the supraspinatus test) may be positive in all of the first three periarticular affections. These provocative maneuver tests proved especially useful in localizing tears of the rotator cuff, determining the choice of surgical access.
The imaging modalities-plain x-rays in different positions, sonography and arthrography-are of prime importance in settling the diagnosis. The latter two though depend on considerable technical and interpretative experience in order to reduce both false-positive and false-negative results.
Despite our growing experience with shoulder sonography we therefore continue to perform arthrographies on a regular basis, in order to identify those ruptures of the cuff that are sonographically silent.
