肩袖损伤(1)教案资料.ppt

肩袖损伤(1)

当我们在临床上遇到疑似病人，只有X片而无MRI检查时，1我们能从X片中得到什么信息？2我们印象中的可疑诊断有哪些？3针对性的体查有哪些？

GazzolaS,BleakneyRR.Currentimagingoftherotatorcuff[J].SportsMedArthrosc,2011,19(3):300-9.cysticchangeofthegreatertuberosity1读X片

GazzolaS,BleakneyRR.Currentimagingoftherotatorcuff[J].SportsMedArthrosc,2011,19(3):300-9.normalsubacromialjointspace(≥7mm)(arrow)1superiorsubluxationofthehumeralhead(arrow)2notchedhumeralneck(arrowhead)

TypeIcalci?cationwitha?uffy,?eecyappearancewithpoorlyde?nedborders,withacutesymptomsandtermedtheresorptivephase.TypeIIcalci?cation,morediscreetandofhomogenousdensity,withwell-circumscribedborders,andintheformativephase.DePalmaAF,KruperJS.Long-termstudyofshoulderjointsaffliatedwithandtreatedforcalci?ctendinitis[J].ClinOrthop.1961;20:61-72.calci?ctendinopathy

2可疑诊断1关于肩周炎肩周炎=冻结肩（《实用骨科学》第3版），是由于肩关节周围软组织病变而引起肩关节疼痛和活动功能障碍。国外报道Frozenshoulder40-60yearsofage,incidence2-5%[1].3phases[2]freezingphase2-9months,painandlossofmotionoftheglenohumeraljointinalldirection，usuallyworstatnightandwhenlyingontheaffectedside2)frozenphase4-12months,stiffnessreachesitsmaximumthawingphase5-12months,rangeofmotionreturnstonormal2肩峰下撞击综合症疼痛，主诉为三角肌下疼痛，并经常向下放射至前方的肱二头肌，夜间疼痛可影响睡眠1HandC,ClipshamK,ReesJL,etal.Long-termoutcomeoffrozenshoulder.JShoulderElbowSurg2008;17:231-6.2ReevesB.Thenaturalhistoryofthefrozenshouldersyndrome.ScandJRheumatol1975;4:193-6.

3针对肩袖损伤的体查1冈上肌肩外展功能1emptycantest1)90degreesabduction2)30degreeshorizontalabduction(intheplaneofthescapula)3)thumbspointingdownward

2fullcantest1)90degreesinthehorizontalplane2)rotated45degreesexternally3)withthethumbpointingupward

painfularctest60°-120°1)shoulderinexternalrotation2)palmfacingup

4resistedisometricabduction1)thearminneutralrotation2)abductsthearmto90degrees

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