肩肋综合征

 The pain may be localized to the medial superior border of the scapula or it may radiate up into the neck, causing headache. It can also cause pain into the root the shoulder, simulating rotator cuff syndrome or other shoulder disorders. It can radiate around the chest wall or down the arm, usually in an ulnar distribution. The characteristic pattern is that of acute pain localized in the upper trunk. There may be complaints of radicular-type pain with or without sensory features. Although weakness of the arm and shoulder may be offered as complaints, these usually are a result of guarding, without atrophy or neurophysiological evidence of denervation on EMG. The pain has been described variously as aching, burning, or gnawing, and rarely as a sharp or radicular pain. The symptoms may be intermittent, but a nagging, constant quality is not uncommon. Insomnia is a frequent complaint, due to inability to find a comfortable sleeping position. 承德医学院附属医院骨科杜志峰

The original paper of Michele  cited an equal distribution between the sexes. Since then, most observers have noted a female predominance, and also a predominance in the dominant shoulder. Clerical occupation, rounded shoulders, the carrying of personal items, including handbags, and large pendulous breast are often implicated.

Russek classified the syndrome into three types: 1) primary, probably postural in origin, 2) secondary, a complication of pre-existing neck or shoulder lesions and 3) static, occurring in severely disabled patients who are unable to control the scapulo-thoracic relationship.

There are usually no muscular, reflex, or sympathetic, or sensory findings in the examination. The classical finding is a trigger point elicited by digital pressure at the medial scapular border in a line extending from the scapular spine. This trigger point may be missed (both diagnostically and therapeutically), unless the arm is adducted, with the palm of the affected hand flat upon the opposite shoulder, crossing in front of the chest. Alternatively, extension and internal rotation of the arm will also elicit the pain. Secondary trigger points may be found in the trapezius and rhomboid.  Diffuse tenderness over the chest wall is usually mild.

No consistent biochemical, rheumatological, radiological, or neurophysiologic (EMG) findings have been reported. One study reported increased heat emission from the upper medial angle of the affected shoulder on thermography, in more than 60% of patients.  Reproduction of the pain by palpation (and relief by local anesthetic infiltration) are the sine-que-non of this syndrome.