肩关节疾病的诊断ppt课件

肩关节疾病的诊断,山东省中医院运动损伤骨科 王少山,肩关节的疾病你知道多少,普通人医务工作者骨科医生运动医学医师肩关节疾病的特征 疼痛 关节僵硬,肩关节解剖,骨结构,Body AnatomyScapulaClavicle,骨结构,Bony AnatomyHumerusRibs,肌肉构成,Anterior musculature of the shoulder girdle,肌肉构成,Musculature of posterior shoulder girdle,韧带结构,Shoulder ligaments,滑囊和盂唇,Shoulder joint capsule and cartilage,血管和神经,Blood Supply and Intervention,肩关节的评估,病史采集疼痛的原因损伤的机制以前的病史疼痛的位置 时限 程度弹响 弹响的数量 体温的变化肩无力？ 肩疲劳?如何减轻疼痛,?,Shoulder Evaluation (Observation),Elevation or depression of shoulder tipsPosition and shape of clavicleAcromion processBiceps and deltoid symmetryPostural assessment (kyphosis, lordosis, shoulders),Position of head and armsScapular elevation and symmetryScapular protraction or wingingMuscle symmetry Scapulohumeral rhythm,肩关节运动范围检查(Observation),肩胛盂肱关节与肩胛胸壁关节肱骨与肩胛骨的运动关系肩关节启动三十度外展肩胛骨不参与运动外展三十度到九十度之间肱骨平均每上抬两度肩胛骨外展向上旋转一度the 九十度以上肩胛骨肱骨呈1：1旋转运动,肩关节检查压疼点 (Palpation),骨结构胸锁关节锁骨干肩锁关节喙突肩峰肱骨头肱骨大结节 肱二头肌间沟肩胛岗肩胛骨内缘,肩胛骨外缘肩胛骨上角肩胛骨下角,肩关节检查压疼点 (Palpation),软组织结构胸锁关肩锁关节 喙锁韧带肩袖肌腱肩峰下滑囊肱二头肌间沟肱二头肌腱喙肩韧带,Glenohumeral joint capsuleDeltoidRhomboidsLatissimus dorsiSerratus AnteriorLevator scapulaeTrapeziusSupraspinatusInfraspinatusTeres major and minor,肩关节特殊检查 (Special Tests),肩关节功能范围(ROM)前屈 180o后伸 50o外展 180o内收 40o内旋 90o外旋 中立位 600 外展位 900,Manual Muscle TestingFive Point grading system5 = Complete ROM against gravity, with full resistance4 = Complete ROM against gravity, with some resistance3 = Complete ROM against gravity, with no resistance2 = Complete ROM, with gravity omitted1 = Some muscle contractility with no joint motion0 = No muscle contractility,肩周炎的概念,历史 1896年Duplay提出 pereglanoiolitis 盂肱关节周围炎 首次医学描述肩僵硬演变 Codman1934年命名为肩周炎 1945年J.S.Neviase第一次使用adhesive capsulitis粘连性肩关节囊炎现状 由于肩关节周围炎的描述模糊不清，病理至今没有病理生理学基础,肩周炎是垃圾箱 弃用,症状模糊不清多种疾病混淆没有清晰的病理生理机制和证据给临床带来混乱,有必要对肩疼痛疾病分类,冻结肩肩峰撞击证肩袖损伤钙化性肌腱炎盂唇损伤肩锁关节骨性关节炎盂肱关节骨性关节炎,冻结肩,有明确的时限性疼痛有固定的曲线有固定的症状和体现没有明确的发病原因最终结局是乐观、一般不留关节障碍,病程分期,冷冻期 初期 1-9个月 疼痛冻结期 中期 3-2个月 关节僵硬解冻期 后期 5个月至2年 疼痛减轻功能恢复,Frozen Shoulder Classifications,Frozen shoulder: Lundberg classificationStages of frozen shoulder: ReevesArthroscopic stages of adhesive capsulitis: Neviaser,Frozen Shoulder: Lundberg Classification,A. Primary frozen shoulder:Shoulder elevation 135 degLimitation of movement only at gleno-humeral articulationRadiology normalOther causes ie trauma, OA, RA, Hemiplegia etc excludedB. Secondary frozen shoulder:Decreased range of movement following trauma or other known cause,Stages of Frozen Shoulder: ReevesReeves B, Scand J Rheumatol, 4: 193-196, 1975,Painful stage: 10-36 weeksStiffness: 4-12 monthsRecovery: 5-24 months,冻结肩是一种自限性疾病不必忧虑