Hemodialysis-related subacromial lesion: diagnostic imaging and minimally invasive treatment

Background: In an attempt to refine the diagnosis and surgical treatment sy stem for spontaneous shoulder pain in supine position (SPSP) in long-term h emodialysis (LTHD) patients ive reviewed shoulders of patients during a 4-y ear period. Patients and methods: Clinical findings, imaging findings and o perative results (average duration of follow-up was 39 months) on both shou lders of 110 patients (Shigei Hospital, Okayama, Japan) were analyzed to id entify the cause of SPSP in order to accurately differentiate it from other shoulder pains, and to select the proper treatment method. Results: As the hemodialysis period lengthened, increase in the incidence and severity of bone and soft tissue changes (radiolucency, joint destruction, increase of thickness of subacromial bursa and rotator cuff, and synovial proliferation ) in the shoulder induced by dialysis-related amyloidosis were noted in roe ntgenography, ultrasonography and magnetic resonance imaging. SPSP occurred in the LTHD patients. An increase in subacromial bursa and rotator cuff th ickness correlated with SPSP. A decrease in subacromial space correlated wi th change in position and SPSP. An increase of subacromial pressure was jud ged to be the cause of SPSP, and subacromial decompression by coraco-acromi al ligament release was effective for relieving SPSP When massive synovial proliferation or invasion of granulation tissues was observed in the glenoh umeral joint, arthroscopic debridement was necessary. Conclusion: SPSP is a sensitive indicator of a distinct subacromial lesion frequently found in L THD patients. These lesions can be treated by minimally invasive endoscopic coraco-acromial ligament release, resulting in marked pain relief.