肩关节疾病的诊断ppt课件.pptVIP

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,Anatomy Review,Shoulder Girdle,Anatomy Review,Bony Anatomy Scapula Clavicle,Anatomy Review,Bony Anatomy Humerus Ribs,Anatomy Review,Anterior musculature of the shoulder girdle,Anatomy Review,Musculature of posterior shoulder girdle,Anatomy Review,Shoulder ligaments,Anatomy Review,Shoulder joint capsule and cartilage,Anatomy Review,Blood Supply and Intervention,Shoulder Evaluation (History),History What is the cause of pain? Mechanism of injury? Previous history? Location, duration and intensity of pain? Creptitus, numbness, distortion in temperature Weakness or fatigue? What provides relief?,?,Shoulder Evaluation (Observation),Elevation or depression of shoulder tips Position and shape of clavicle Acromion process Biceps and deltoid symmetry Postural assessment (kyphosis, lordosis, shoulders),Position of head and arms Scapular elevation and symmetry Scapular protraction or winging Muscle symmetry Scapulohumeral rhythm,Shoulder Evaluation (Observation),Scapulohumeral Rhythm Movement of scapula relative to the humerus Initial 30 degrees of glenohumeral abduction does not incorporate scapular motion (setting phase) 30 to 90 degrees the scapula abducts and upwardly rotates 1 degree for every 2 degrees of humeral elevation Above 90 degrees the scapula and humerus move in 1:1 ratio,Shoulder Evaluation (Palpation),Bony Structures Sternoclavicular joint Clavicular shaft Acromioclavicular joint Coracoid process Acromion process Humeral head Greater and lesser tuberosity Bicipital groove Spine of scapula Scapular vertebral border,Scapular lateral border Scapular superior angle Scapular inferior angle,Shoulder Evaluation (Palpation),Soft Tissue Palpation Sternoclavicular, acromioclavicular and coracoclavicular ligaments Rotator cuff muscles and tendons Subacromial bursa Sternocleidomastoid Biceps and tendon Coracoacromial ligament,Glenohumeral joint capsule Deltoid Rhomboids Latissimus dorsi Serratus Anterior Levator scapulae Trapezius Supraspinatus Infraspinatus Teres major and minor,Shoulder Evaluation (Special Tests),Active Range of Motion (ROM) Flexion 180o Extension 50o Abduction 180o Adduction 40o Internal Rotation 90o External Rotation 90o,Manual Muscle Testing Five Point grading system 5 = Complete ROM against gravity, with full resistance 4 = Complete ROM against gravity, with some resistance 3 = Complete ROM against gravity, with no resistance 2 = Complete ROM, with gravity omitted 1 = Some muscle contractility with no joint motion 0 = 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 19个月=疼痛 冻结期 中期3-12个月=关节僵硬 解冻期 后期5个月-2年=疼痛减轻 功能恢复,冻结肩是一种自限性疾病 不必忧虑,如何确诊冻结肩,病史 没有明确的原因 疼痛的特点 疼痛逐渐加重，夜间疼痛 关节僵硬 逐渐盂肱关节的活动度减少 肌肉无损伤 肌力无明显改变,临床检查,肩关节功能 ROM 前屈外展上抬 0度180度 外旋 0度60度 内旋 体侧6、7胸椎棘突 全方位功能受限,辅助检查,影像学没有明确的阳性改变,MRI,肩峰撞击症,何为肩峰撞击症 肩峰撞击症的概念 Neer提出肩关