Clinical diagnostic features of Keegan′s disease

doi:10.3877/cma.j.issn.2095-655X.2022.02.013

Abstract

Abstract:

Objective

To explore the clinical diagnostic features and the causes of misdiagnosis of Keegan′s disease.

Methods

3 patients with Keegan's disease treated in Orthopedics Department of Air Force Medical Center Affiliated to Air Force Medical University from March 2018 to December 2020 were selected. Their diagnosis, differential diagnosis and outcomes were analyzed, and the relevant literatures were reviewed.

Results

There were 3 patients, 1 male and 2 females, aged 36, 36 and 47 years old, respectively. All the patients had restricted abduction of the right shoulder without obvious inducement, and lateral soreness when lifting the right upper arm. The muscle strength of deltoid muscle and biceps brachii of the right upper limb was significantly reduced, with no symptoms and signs of spinal cord damage and paresthesia. There were typical selective "high spots" in MRI T₂WI, and clear neurological damage of the deltoid and biceps in electrophysiology, in line with all the clinical features of Keegan′s disease. With conservation treatment, all patients began to get better 2 to 3 weeks and recovered 11 to 13 weeks after onset.

Conclusion

Shoulder abductor dysfunction without paresthesia is a typical clinical feature of Keegan′s disease.

Key words: Keegan′s disease, Shoulder joint, Dissociated motor loss in upper extremity, Diagnosis, differential

Chao Zheng, Junpeng Liu, Junjie Du, Wei Ma, Xuanyu Chen, Ji Wu. Clinical diagnostic features of Keegan′s disease[J]. Chinese Journal of Diagnostics(Electronic Edition), 2022, 10(02): 132-136.

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Figures/Tables 4

References 14

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序号	年龄(岁)	性别	部位	临床主要症状	主要体格检查
1	36	男	右肩部	右肩主动外展障碍伴轻度的疼痛7 d，夜间痛不明显。无饮水呛咳及吞咽困难，二便正常，其余肢体及面部无不适	右侧三角肌轻度萎缩，肌力2^＋级；肱二头肌无萎缩，肌力3级；肱三头肌、肩胛下肌、前臂肌群、手内在肌肌力5级；右上肢深、浅感觉无障碍；抬离试验(－)，压腹试验(－)，肱二头肌腱抗阻试验(－)；肱二头肌腱反射减弱，双侧霍夫曼征(－)；颅神经及下肢神经系统检查无异常
2	36	女	右肩部	无诱因出现右肩部外展活动无力6 d，前方上举困难，偶有夜间痛。无饮水呛咳及吞咽困难，二便正常，其余肢体及面部无不适	右侧三角肌无萎缩，肌力2级；肱二头肌无萎缩，肌力3级；肱三头肌、肩胛下肌、前臂肌群、手内在肌肌力均为5级；深、浅感觉无障碍；抬离试验(－)、压腹试验(－)，肱二头肌腱抗阻试验(＋)；肱二头肌腱反射减弱，双侧霍夫曼征(－)；颅神经及下肢神经系统检查无异常
3	47	女	右肩部	7 d前晨起后感右肩部外展受限，上举活动无力，梳头困难，逐渐加重，无肩部夜间痛。无饮水呛咳及吞咽困难，二便正常，其余肢体及面部无不适	右侧三角肌无萎缩，肌力2^－级；肱二头肌无萎缩，肌力2级；肱三头肌、肩胛下肌、前臂肌群、手内在肌肌力均为5级；抬离试验(＋)、压腹试验(－)，肱二头肌腱抗阻试验(＋)，燕尾征(＋)；深、浅感觉无障碍，肱二头肌腱反射减弱，双侧霍夫曼征(－)；颅神经及下肢神经系统检查无异常

序号	年龄(岁)	性别	部位	临床主要症状	主要体格检查
1	36	男	右肩部	右肩主动外展障碍伴轻度的疼痛7 d，夜间痛不明显。无饮水呛咳及吞咽困难，二便正常，其余肢体及面部无不适	右侧三角肌轻度萎缩，肌力2^＋级；肱二头肌无萎缩，肌力3级；肱三头肌、肩胛下肌、前臂肌群、手内在肌肌力5级；右上肢深、浅感觉无障碍；抬离试验(－)，压腹试验(－)，肱二头肌腱抗阻试验(－)；肱二头肌腱反射减弱，双侧霍夫曼征(－)；颅神经及下肢神经系统检查无异常
2	36	女	右肩部	无诱因出现右肩部外展活动无力6 d，前方上举困难，偶有夜间痛。无饮水呛咳及吞咽困难，二便正常，其余肢体及面部无不适	右侧三角肌无萎缩，肌力2级；肱二头肌无萎缩，肌力3级；肱三头肌、肩胛下肌、前臂肌群、手内在肌肌力均为5级；深、浅感觉无障碍；抬离试验(－)、压腹试验(－)，肱二头肌腱抗阻试验(＋)；肱二头肌腱反射减弱，双侧霍夫曼征(－)；颅神经及下肢神经系统检查无异常
3	47	女	右肩部	7 d前晨起后感右肩部外展受限，上举活动无力，梳头困难，逐渐加重，无肩部夜间痛。无饮水呛咳及吞咽困难，二便正常，其余肢体及面部无不适	右侧三角肌无萎缩，肌力2^－级；肱二头肌无萎缩，肌力2级；肱三头肌、肩胛下肌、前臂肌群、手内在肌肌力均为5级；抬离试验(＋)、压腹试验(－)，肱二头肌腱抗阻试验(＋)，燕尾征(＋)；深、浅感觉无障碍，肱二头肌腱反射减弱，双侧霍夫曼征(－)；颅神经及下肢神经系统检查无异常

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