Casistica ragionata sulla patologia di spalla

Caso 1

Uomo di 55 aa che sollevando un peso alcuni giorni prima ha accusato  improvviso dolore alla regione  scapolo-omerale, seguito da impotenza funzionale nei movimenti di elevazione ed extrarotazione.

Nel contesto di una involuzione del tendine (freccia azzurra) che segnalata in RM da  tenue iperintensità di segnale intraparenchimale, si rileva lesione focale a tutto spessore del tendine sovraspinoso (freccia rossa), senza retrazione del tendine; si sovrappone flogosi perilesionale e versamento nel cavo articolare (freccia verde) e nella borsa sotto-acromion-deltoidea (freccia arancione);

Caso 2

Donna di 63 anni  che progressivamente  ha manifestato  impotenza funzionale nell’elevazione ed extrarotazione del braccio.

 

 

Immagine coronale SE T1 pesata parallela al decorso del muscolo sovraspinoso: le frecce gialle indicano la lesione completa del tendine sovraspinoso che risulta retratto medialmente  oltre l’articolazione acromion-claveare; la freccia azzurra indica la presenza di osteofita del margine inferiore dell’acromion, per effetto di manifestazioni artrosiche, che rientra come concausa della lesione ed espressione comunque di un quadro di   tendinopatia cronica che si è conclusa con il distacco del tendine. La freccia verde indica l’ipotrofia del muscolo sovraspinoso; la freccia  rossa indica il tendine capo lungo del bicipite sano, nel suo decorso craniale extracapsulare.

 

 

Immagine sagittale SPIR T2 pesata. Le frecce azzurre mostrano l’osteofitosi marginale inferiore acromion-claveare responsabile di poetnziale impingement con il tendine sovraspinoso; le frecce gialle mostrano la “disabitazione” della porzione trochitica in corrispondenza dell’area di decorso ed inserzione del tendine sovraspinoso, espressione pertanto di lesione completa; la freccia rossa indica la porzione intra-articoalre, normale, del tendine capo lungo del bicipite; risultano integri il tendine sottoscapolare, nelle sue tre principali porzioni (frecce arancioni), ed il tendine sottospinoso (freccia bianca); C= processo coracoide, che aiuta l’esaminatore ad individuare nelle immagini sagittali la direzione anteriore. 

Caso 3

Donna di 65 anni che accusa dolore ad entrambe le spalle, resistente ai FANS. Giunge all’esame RM senza aver eseguito esami radiografici.

Caso 4

Ragazzo di 35 anni al controllo dopo 7 gg da incidente automobilistico nel quale ga riportato la lussazione della spalla.

Si evidenzia incisura della porzione mediale della testa omerale ed edema della relativa componente spongiosa espressione di recente lesione traumatica da impatto   (inversion Hill-Sachs). Si evidenzia consensuale lesione dell’apparato capsulo labrale posteriore e della componente posteriore del legamento glenomerale inferiore e lieve infarcimento flogistico della componente miotendinea del muscolo piccolo rotondo. Si rileva interessamento distrattivo del legamento coraco-omerale. Il cavo articolare presenta modico versamento. Non sono evidenti lesioni dei restanti cercini glenoidei. Non si osservano significative alterazioni strutturali a carico delle componenti tendinee della cuffia dei rotatori.  Non sono presenti alterazioni del decorso e della struttura del tendine capo lungo del bicipite.

 

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