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© 1990 British Society for Rheumatology

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DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH) OF THE SHOULDER: A CAUSE OF SHOULDER PAIN?

CH. BEYELER*, P. SCHLAPBACH*, N. J. GERBER*,, J. STURZENEGGER*, H. FAHRER*, SJ. VAN DER LINDEN*, U. BÜRGI{dagger}, W. A. FUCHS{ddagger} and H. EHRENGRUBER§

*Departments of Rheumatology, University of Berne Inselspital, CH-3010 Berne, Switzerland
{dagger}Departments of Internal Medicine, University of Berne Inselspital, CH-3010 Berne, Switzerland
{ddagger}Departments of Radiology, University of Berne Inselspital, CH-3010 Berne, Switzerland
§Departments of Data Processing, University of Berne Inselspital, CH-3010 Berne, Switzerland

Correspondence to: Correspondence to Prof N. Gerber, Department of Rheumatology, University of Berne, Inselspital, CH-3010 Berne, Switzerland

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (X2= 5.90, F>0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, x2 = 4.06, F>0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, x2 = 6.64, P>0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance

KEY WORDS: Shoulder, Hyperostosis, Forestier's disease, Ankylosing vertebral hyperostosis, Radiographs, Pain


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