肩袖损伤英文版.ppt

Rotator Cuff Injury Rotator Cuff Supraspinatus, up facet of the humeral greater tuberosity Infraspinatus, middle facet of the humeral greater tuberosity Teres minor down facet of the humeral greater tuberosity Infraspinatus Humeral tuberosity MRI Infraspinatus Teres minor Supraspinatus Infraspinatus Pathophysiology Intrinsic Factors Vascular supply (? significance) Distal 1cm of supraspinatus tendon (early studies) Degenerative changes Age related Change in proteoglycan and collagen content in symptomatic tendons Pathophysiology Extrinsic factors Impingement Acromial spurs Type III acromion and decreased geometric area of the supraspinatus outlet Coracoacromial ligament AC joint osteophytes Coracoid process Glenohumeral instability Accentuates abnormal loading Can lead to internal impingement Repetitive use Tensile overload Muscle fatigue Microtrauma Mechanism Traumatic Pitching Chronic…… Diagnose 1、History Pain on the lateral aspect of the shoulder Stiffness, esp IR Cannot lie on that side Weakness, instability, crepitus Partial tears more sore and stiffer Acute tear may have inciting event Diagnose 2、Physical Exam Impingement testing NEER SIGN Hawkins test Diagnose 2、Physical Exam SUBSCAPLULARIS 肩胛下肌 SUPRASPINATUS 冈上肌 Jobes Test Diagnose 2、Physical Exam INFRASPINATUS 冈下肌 TERES MINOR 小圆肌 Hornblowers sign: Diagnose 3、Imaging Plain radiographs Ultrasound MRI small (1 cm), medium (1–3 cm), large(3–5 cm), or massive (5 cm） Treatment-surgery 三角肌 三角肌 肱三头肌外侧头 肱二头肌 肱骨头 肩胛下肌