肩的疼痛2015重点.ppt

肩手综合症　Shoulder Hand Syndrome ?麻痹侧上肢的肌肉活动低下　　　 肌肉血流减少 Decrease of muscle activities of an affectted upper extremity Decrease of blood flow in muscles ?皮肤骨组织的血流增加　Increase of blood flow in skins and bones reversely ?局部的代谢障碍　　　　微循环恶化、神经激肽产生 伤害感受器的向心性冲动增加　　Poor local metabolism Inflammation of soft tissues and a lot of production of neurokinin　　　　　Increase of afferent impulses from nociceptors ?内环境稳定，有促使皮肤骨组织增加的血流正常化的作用　　　　　Reactions to normalize the increase of blood flow of skins and bones by homeostasis ?但是交感神经活动亢奋。 　①细小动脉收缩　②交感神经和躯体感觉神经产生去甲肾上腺素的化学信号，增加向心性冲动，在脊髓水平，反射性的交感神经兴奋。 Activities of sympathetic nerves becomes higher. ①Capillaries contract. ②In sympathetic nerves and sensory nerves, chemical transmission of noradrenalin happens, and then afferent impulses increase. In spinal cord, sympathetic nerves reflexively excite. (Ishibashi 2002) 石橋徹：反射性交感神経性ジストロフィー. 「肩の痛み」 　 寺山和雄?片岡治（監修）、pp183-197、2002. 　　　　　　　　　　　　　　　　　 Cailliet R : 肩の痛み（第３版）.荻島秀男（訳）、医歯薬出版、p65、2004. trauma trauma serotonin contraction of vessel blood platelet dilation of vessel histamine heparin edema edema mechanically P-substances prostaglandin-E bradykinin spasms edema occlusion of blood flow phospholipids arachidonic acid 浮肿的机制　Mechanism of Edema transmission Cailliet R : 肩の痛み（第３版）.荻島秀男（訳）、医歯薬出版、pp257-260、2004. pump pump artery vein limitation of flexion and pumping action Pumps for Vein and Lymph in Upper Extremity ■上肢、手和胸廓全体的肌肉收缩过程中，浮肿也会减轻。 　 In the process to recover normal contraction of the affected arm and hand and ribcage, edema is decreased. 大范围的麻痹侧上下肢安静时自发疼痛的对策　　　　 　Approach to spontaneous and extensive pain at rest　 ■宽动作范围神经元（WDR神经元）处于过敏状态，同时具有对麻痹侧肩运动时疼痛和局部疼痛的镇静效果。 Wide