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[The enthesopathic shoulder].

B Fournié, J J Railhac, P Monod

    Revue Du Rhumatisme Et Des Maladies Osteo-Articulaires
    |June 1, 1987
    PubMed
    Summary
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    Rheumatoid diseases differ significantly from ankylosing spondylitis, psoriatic rheumatism, and hyperostosis. Specific shoulder enthesophytes, like the "bearded acromion," aid in differentiating these rheumatic conditions.

    Area of Science:

    • Rheumatology
    • Orthopedic Radiology

    Background:

    • Shoulder involvement is common in various rheumatic diseases.
    • Differentiating between rheumatoid disease, spondyloarthropathies, and hyperostosis can be challenging based on radiographic findings.
    • Enthesophytes, bony spurs at tendon or ligament insertions, are key radiographic features.

    Purpose of the Study:

    • To compare radiographic shoulder findings in rheumatoid disease, ankylosing spondylitis, psoriatic rheumatism, and hyperostosis (Forestier's disease).
    • To identify specific radiographic markers that differentiate these conditions.
    • To investigate the significance of enthesophytes and humeral head sulcus ulcerations.

    Main Methods:

    • Analysis and comparison of radiographic shoulder images from 61 cases of rheumatoid disease, 23 of ankylosing spondylitis, 22 of psoriatic rheumatism, and 30 of hyperostosis.

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  • Focus on the presence and location of enthesophytes, particularly the 'bearded acromion'.
  • Evaluation of humeral head sulcus ulcerations in relation to specific diagnoses.
  • Main Results:

    • Significant differences were observed between rheumatoid disease and the other conditions.
    • Enthesophytes were present in ankylosing spondylitis, psoriatic rheumatism, and hyperostosis, but typically absent in rheumatoid disease unless co-existing with hyperostosis.
    • The 'bearded acromion' (acromial insertion of the acromio-coracoid ligament) was the most frequent enthesophyte and easily visualized.
    • The combination of a 'bearded acromion' and a humeral head sulcus ulceration was characteristic of spondyloarthropathies (ankylosing spondylitis, psoriatic rheumatism) but not hyperostosis.
    • Humeral head sulcus ulcerations were common in both spondyloarthropathies and rheumatoid disease, likely due to synovitis rather than enthesopathy.

    Conclusions:

    • Radiographic shoulder analysis, particularly the presence of specific enthesophytes like the 'bearded acromion', can help differentiate rheumatoid disease from spondyloarthropathies and hyperostosis.
    • The association of 'bearded acromion' with sulcus ulceration is a strong indicator of spondyloarthropathies.
    • Humeral head sulcus ulcerations appear to be related to synovitis in rheumatoid disease and spondyloarthropathies, not inflammatory enthesopathy.