肩关节疾病的诊断解读.ppt

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) Shoulder Evaluation (Palpation) 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 jo