肩关节临床检查方法.ppt

肩关节的临床检查方法Clinicaltestsinshoulderexamination:howtoperformthem,Catalogue,IntroductionBackgroundContentMygainsAdvantages,Introduction,来自：group.bmj发表日期：March15,2019作者：MaartenHendrikMoen,Robert-JandeVos,ToddSEllenbecker,AdamWeir通讯作者：MaartenHendrikMoen,Background,Theshoulderisoftenconsideredadifficultjointtoexamine,andthisispartlyduetothelargenumberofdifferentclinicaltestsofshoulderfunction.肩关节通常被认为是一种很难检查的关节，在一定程度上是因为临床上肩关节功能的检查方法较多。Thecommonestshoulderinjuriesinclude:impingement,rotatorcuffinjuries,labraltears,instabilityandacromioclaviculardysfunction.常见的肩关节损伤包括：肩峰撞击综合征、肩袖的损伤、盂唇的损伤、肩关节的不稳定性以及肩锁关节的功能障碍。,Theshoulder,盂肱关节glenohumeraljoint肩锁关节acromioclavicularjoint胸锁关节sternoclavicularjoint肩肱关节（肩胛下间隙）subacromiclspace肩胛胸廓关节Scapularthoracicjoint也有将喙锁间联系称为喙锁关节Coracoclavicularjoint,盂肱关节glenohumeraljoint,肱骨头humeralhead盂窝glenoidcavity盂唇glenoidlabrum关节囊articularcapsule韧带ligament支持结构supportingstructure,盂肱关节glenohumeraljoint,关节盂,关节囊articularcapsulethinandlax,luxateinthefrontandbottom,肩锁关节acromioclavicularjoint,肩锁韧带Acromioclavicularlig.喙锁韧带Coracoclavicularlig.斜方韧带Trapezoidlig.锥状韧带Conoidlig.,胸锁关节sternoclavicularjoint,鞍状关节sellarjiont韧带组织ligament胸锁前韧带胸锁后韧带胸锁上韧带锁间韧带肋锁韧带关节盘articulardisc,肩胛下间隙subacromicalspace,肱骨头与喙肩韧带之间humeralhead,Coracoacromiallig.肩峰acromion喙肩韧带Coracoacromiallig.喙突coracoidprocess肩锁关节acromioclavicularjoint内容物：肩峰下滑囊subacromicalbursa肩袖rotatorcuff二头肌长头腱tendonoflongheadofbicepsbrachii,肩袖rotatorcuff,肩胛下肌：内收、旋内Subscapularis:adduction,medialrotation冈上肌：外展Supraspinatus:abduction冈下肌：旋外Infraspinatus:externalrotation小圆肌：旋外Teresminor:externalrotation,Content,Thisarticlewilldescribethebestclinicalshouldertestsasratedinthissystematicreviewandmeta-analysisoftheindividualtests.这篇文章描述了在综述中被评估为最好的临床上的肩关节的检查方法。,Test,Impingementtests撞击试验Rotatorcufftests肩袖试验SuperiorlabrumanteriortoposteriorlesionstestsSLAP损伤试验Instabilitytests不稳定试验Acromioclaviculartests肩锁关节试验,撞击试验,Neer征(筛查screen)HawkinsKennedy试验(筛查screen)空罐试验（确诊confirm）,撞击试验,Neer征阳性：肩部疼痛注射10ml的利多卡因来缓解疼痛inject10mloflidocaine意义：肱骨大结节撞击发生炎性的冈上肌以及肩峰下滑囊Thetuberculummajusimpingesthedegeneratedsupraspinatusandsubacromialbursaagainsttheacromion,HawkinsKennedy试验阳性：被动内旋导致疼痛painwithforcedinternalrotation意义：肱骨大结节促使冈上肌肌腱撞击韧带Thetuberculummajusforcesthesupraspinatustendonagainstthecoracoacromialeligament,空罐试验Emptycantest阳性：肩部疼痛意义：冈上肌的强度测试。肩胛下肌、冈下肌和小圆肌的电位相对不变。Strengthtestofthesupraspinatusmuscle.Thesubscapularis,infraspinatusandteresminorareelectricallycomparativelysilentinthisposition.,Rotatorcufftests肩袖试验,外旋减弱征Externalrotationlagsign落臂征Droparmtest（假阳性）仰卧撞击试验Supineimpingementtest腹部按压试验Bellypresstest,Rotatorcufftests肩袖试验,外旋减弱征Externalrotationlagsign阳性：手臂掉落anangulardropoccur意义：手臂下落5提示冈上肌腱或者冈下肌腱的局部撕脱Alagsignofmorethan5isa(partial)tearoftheinfraspinatusorsupraspinatustendons.,落臂征Droparmtest阳性：患者身体可能会偏向受影响的一侧，并且会突然缩短两臂的伸展长度。Thepatientmayleantotheaffectedsideandmaylowerthewholearmquitesuddenlyinabduction.意义：评定冈上肌和冈下肌的损伤Thistestisdesignedfortheassessmentofsupraspinatusandinfraspinatusinjuries,仰卧撞击试验Supineimpingementtest阳性：疼痛的增加anincreasepain意义：评定肩袖损伤。疼痛可能是由于肩峰下间隙狭窄和加压造成的。Assessanyrotatorcufftear.Painresultsfromnarrowingandcompressingthesubacromailspace.,腹部按压试验Bellypresstest阳性：患者不能保持肩关节最大限度的内旋。肘关节向后移动，肩内旋消失。Thepatientcantmaintainmaximalinternalrotation.Theelbowdropsbackwards,andinternalrotationislost意义：评定肩内旋活动度的减小Assessdecreasedinternalrotation.,SuperiorlabrumanteriortoposteriorlesionstestsSLAP损伤试验,前方滑动试验Anteriorslidetest（确诊）肱二头肌负重试验BicepsloadIItest（确诊）,前方滑动试验Anteriorslidetest阳性：肩的疼痛或声响painoraclickinthefrontoftheshoulder意义：肱骨头前后的运动会对上盂唇产生压力。肱骨头前方的运动也会导致肱二头肌腱的牵伸，最终导致上唇复合体的伸展。Anteriorandsuperiorhumeralheadtranslationsallowstresstothesuperiorlabrum.Theupwardmotionalsocausestractiononthebicepstendon,stretchingthelabralcomplex.,肱二头肌负重试验BicepsloadIItest阳性：疼痛或加重的疼痛painormorepain意义：上盂唇从关节窝边缘的剥落和疼痛的加重Thesuperiorlabrumispeeledoftheglenoidmarginandpainincreases.,不稳定试验Instabilitytests,恐惧试验Apprehensiontest再复位试验Relocationtest前方释放试验Anteriorreleasetest,恐惧试验Apprehensiontest阳性：肩关节突然的恐惧感和疼痛Thereisasuddenapprehensionfeelingintheshoulderandpain.意义：组合的运动和向前的直接压力会导致肩关节半脱位。Thecombinedmotionandanteriordirectedpressurecausessubluxationoftheshoulder.,再复位试验Relocationtest阳性：疼痛的减轻，患者能够忍受的最大的肩外旋位置Thereisareliefofpainandthepatientisabletotoleratemaximalexternalrotation.意义：向后的力把肱骨头固定在适当的位置上Theposteriordirectedforcemaintainsthehumeralheadinposition.,前方释放试验Anteriorreleasetest阳性：疼痛/疼痛加剧Thereisasuddenpain/anincreaseinpain.意义：释放后加的力量后，肱骨头向前方半脱位Releasingtheposteriorlydirectedforce,thehumeralheadcansubluxateanteriorly.,Acromioclaviculartests肩锁关节试验,OBrien试验（确诊）肩锁关节压痛试验ACjointtendernesstest（筛查）,OBrien试验阳性：肩锁关节周围的疼痛更多的表现在抵抗内旋上Thereisapainaroundtheacromioclavicular(AC)joint,morepresentwithresistedinternalrotation意义：肱骨大结节挤推肩峰使肩锁关节受压Theacromionispushedbythetuberculummajus,compressingtheACjoint,肩锁关节压痛试验ACjointtendernesstest阳性：疼痛,Mygains,学习并掌握了多种有效的临床肩关节检查方法；Welearnandmastermanyeffectiveclinicalshoulderjointinspectionmethods2.在今后的学习中，要侧重对于学习的概括；Inthefuture,wewillfocusonlearninggeneralization;3.临床检查中要重视个体化检查以得到正确有效的结果。Weshouldpayattentiontotheindividualchecktogetcorrectresultsintheclinicalexamination.,Advantages,文章结构清晰，图文并茂，一目了然；Thisarticlehasclearstructureandphotographsoftheexacttestprocedure;2.文章研究方向明确，对怎样执行肩关节临床检查做了一个实用性