Supraspinatus tendinopatilerinde kantitatif shear wave ultrasonografik elastografi inceleme
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ VE AMAÇ: Omuz ekleminde rotator manşet tendinopatileri günlük hayatta ağrı ve hareket kısıtlılığının en sık nedenlerindendir. Bu nedenle görüntüleme erken tanı ve erken tedavi için önemlidir. Gelişen teknoloji ile ultrasonografik elastografi (USE) isimli yöntemde anatomik ve morfolojk özelliklerin yanı sıra sertlik, elastisite ve biyomekanik özelliklere dair kalitatif ve kantitatif veri elde etmek mümkündür. Çalışmamızda B mod USG bulguları ile m/sn cinsinden shear wave elastografik (SWE) hız ölçümleri arası ilişkiyi tespit etmek, ikincil olarak da hız ölçümleri ile constant murley klinik skoru (CMS) arası ilişki ve korelasyonu ortaya koymak amaçlandı. GEREÇ VE YÖNTEM: Ocak 2019 ile Mart 2021 tarihleri arasında tetkik edilmiş, pacs arşivimizde kaydedilmiş B mod omuz USG ve USE görüntüleri ile hasta dosyalarında CMS skoru değerlendirmesi olan toplamda 75 hastada 150 omuz çalışmaya dahil edildi. Bulgular retrospektif değerlendirildi. B mod USG’de dikkat edilen kriterler tendonun ekojenitesi, fibriler yapının homojenliği ve tendon kalınlıkları idi.SWE’de ise ölçümler süpraspinatus tendonlarından crass pozisyonunda, hafif aktif kasılı durumda, manuel olarak tendonun uygun noktalarından ve mümkün olan aynı derinlikte 4-6 adet ROI kullanılarak yapılmıştır. Elde edilen veriler non parametrik istatistiksel testler ve korelasyon testleri ile SPSS programında değerlendirildi. Çalışmamızda 20-9T/29 numaralı kararı ile onaylı etik kurul onayı ve hastalardan alınmış aydınlatılmış yazılı onam formları mevcuttur. BULGULAR: 150 omuzdan 81’i semptomatik, 69’u asemptomatikti. 81 semptomatik omuzdan 29’unda süpraspinatus patolojisi saptanmadı. Geriye kalan 52 omuzda süpraspinatus tendonlarında tendinozis veya yırtık izlendi. 69 asemptomatik omuzdan 47’sinde süpraspinatus patolojisi izlenmedi. 22 omuzda asemptomatik olmasına rağmen B mod USG’de süpraspinatusta yırtık veya tendinozis izlendi.Semptomatik grupta B mod USG’de tendinozis ve yırtık anlamlı olarak daha yüksek bulundu. Ortanca hız değerleri semptomatik grupta anlamlı düşük bulundu. Tendinopati varlığında supraspinatus tendonlarında USE’de shear wave hız değerleri düşmektedir. Klinik ağrı skoru ile shear wave hız değerleri arasında ilişki saptanmamıştır. Yaş ile shear wave hız değerleri arası anlamlı ilişki bulunmadı. Ağrı süresi 12 ay ve üzeri olanlarda hız değerleri daha düşük bulundu. Semptomatik grupta kadınlarda hız değerleri anlamlı düşük saptandı. SONUÇ: Süpraspinatusta tendinopatilerinde shear wave hız değerleri düşmekte ve tendon yumuşamaktadır. Semptomatik omuzlarda ortanca hız değerleri daha düşük çıkmaktadır. Tendinopatiye yırtık eklendiğinde shear wave hız değerleri anlamlı farklılık göstermemiştir. Süpraspinatus tendinopatilerinde SWE, CMS’e göre tendon durumunu daha iyi göstermektedir. CMS süpraspinatus dışı rotator manşet tendinopatilerinde tendon durumunu göstermede faydalı olabilir. Çalışmamızda SWE, B mod USG’ye yansımayan erken tendinopatik değişikliği net ortaya koyamamıştır. Bu sonuca kontrol gurubu olarak normal kişilerin omuz eklemi yerine, bir tarafı semptomatik hastanın karşı asemptomatik omuzunu kullanmamız etki etmiş olabilir.
PURPOSE Rotator cuff tendinopathies in the shoulder joint are the most common causes of pain and limitation of movement in daily life. Therefore, imaging is important for early diagnosis and early treatment. With the developing technology, it is possible to obtain qualitative and quantitative data on anatomical and morphological properties as well as hardness, elasticity and biomechanical properties in the method called ultrasonographic elastography (USE).It was aimed to determine the relationship and correlation between shear wave velocity measurements with B mode USG and constant Murley clinical shoulder score (CMS). MATERİALS AND METHODS A total of 150 shoulders in 75 patients who were examined between January 2019 and March 2021 and had B mode shoulder USG and USE images recorded in our pacs archive and CMS score evaluation in the patient files were included in the study. The findings were evaluated retrospectively. The criteria considered in B mode USG were echogenicity of the tendon, homogeneity of the fibrillar structure and tendon thicknesses.In SWE, the measurements were made from the supraspinatus tendons in the crass position, in the slightly active twitch state, manually from the appropriate points of the tendon and at the same depth as possible, using 4-6 ROIs. The data obtained were non-parametric statistical tests and It was evaluated in the SPSS program with correlation tests.In our study, the approval of the ethics committee with the decision numbered 20-9T/29 and the written informed consent forms obtained from the patients are available. RESULTS Out of 150 shoulders, 81 were symptomatic and 69 were asymptomatic.No supraspinatus pathology was detected in 29 of 81 symptomatic shoulders. Tendinosis or tear in the supraspinatus tendons was observed in the remaining 52 shoulders.Supraspinatus pathology was not observed in 47 of 69 asymptomatic shoulders. Supraspinatus tear or tendinosis was observed on USG. Tendinosis and tear were found significantly higher in B mode USG in the symptomatic group. Median velocity values were significantly lower in the symptomatic group. In the presence of tendinopathy, shear wave velocity values decrease in supraspinatus tendons in USE. No correlation was found between clinical pain score and shear wave velocity values.There was no significant relationship between age and velocity values. Shear wave velocity values was found to be lower in those with pain duration of 12 months and above. Median velocity values were found to be significantly lower in women in the symptomatic group. CONCLUSİON In supraspinatus tendinopathies, shear wave velocity values decrease and tendon softens. Median velocity values is lower in symptomatic shoulders. Shear wave velocity values did not differ significantly when tear was added to tendinopathy.In supraspinatus tendinopathies, SWE shows tendon condition better than CMS. CMS may be useful in demonstrating the tendon status in non-supraspinatus rotator cuff tendinopathies. In our study, SWE could not clearly reveal the early tendinopathic change that was not reflected in B-mode USG. Our use of the opposite asymptomatic shoulder of the patient who was symptomatic on one side, instead of normal people as a control group, may have affected this result.
PURPOSE Rotator cuff tendinopathies in the shoulder joint are the most common causes of pain and limitation of movement in daily life. Therefore, imaging is important for early diagnosis and early treatment. With the developing technology, it is possible to obtain qualitative and quantitative data on anatomical and morphological properties as well as hardness, elasticity and biomechanical properties in the method called ultrasonographic elastography (USE).It was aimed to determine the relationship and correlation between shear wave velocity measurements with B mode USG and constant Murley clinical shoulder score (CMS). MATERİALS AND METHODS A total of 150 shoulders in 75 patients who were examined between January 2019 and March 2021 and had B mode shoulder USG and USE images recorded in our pacs archive and CMS score evaluation in the patient files were included in the study. The findings were evaluated retrospectively. The criteria considered in B mode USG were echogenicity of the tendon, homogeneity of the fibrillar structure and tendon thicknesses.In SWE, the measurements were made from the supraspinatus tendons in the crass position, in the slightly active twitch state, manually from the appropriate points of the tendon and at the same depth as possible, using 4-6 ROIs. The data obtained were non-parametric statistical tests and It was evaluated in the SPSS program with correlation tests.In our study, the approval of the ethics committee with the decision numbered 20-9T/29 and the written informed consent forms obtained from the patients are available. RESULTS Out of 150 shoulders, 81 were symptomatic and 69 were asymptomatic.No supraspinatus pathology was detected in 29 of 81 symptomatic shoulders. Tendinosis or tear in the supraspinatus tendons was observed in the remaining 52 shoulders.Supraspinatus pathology was not observed in 47 of 69 asymptomatic shoulders. Supraspinatus tear or tendinosis was observed on USG. Tendinosis and tear were found significantly higher in B mode USG in the symptomatic group. Median velocity values were significantly lower in the symptomatic group. In the presence of tendinopathy, shear wave velocity values decrease in supraspinatus tendons in USE. No correlation was found between clinical pain score and shear wave velocity values.There was no significant relationship between age and velocity values. Shear wave velocity values was found to be lower in those with pain duration of 12 months and above. Median velocity values were found to be significantly lower in women in the symptomatic group. CONCLUSİON In supraspinatus tendinopathies, shear wave velocity values decrease and tendon softens. Median velocity values is lower in symptomatic shoulders. Shear wave velocity values did not differ significantly when tear was added to tendinopathy.In supraspinatus tendinopathies, SWE shows tendon condition better than CMS. CMS may be useful in demonstrating the tendon status in non-supraspinatus rotator cuff tendinopathies. In our study, SWE could not clearly reveal the early tendinopathic change that was not reflected in B-mode USG. Our use of the opposite asymptomatic shoulder of the patient who was symptomatic on one side, instead of normal people as a control group, may have affected this result.
Açıklama
Anahtar Kelimeler
Supraspinatus, Rotator Manşet, Tendinozis, Constant Murley, Shear Wave Elastografi, Supraspinatus, Rotator Cuff, Tendinosis, Constant Murley, Shear Wave Elastography
