常见的肩关节镜基础.ppt

DIAGNOSTIC ARTHROSCOPY “ ” 肩关节镜基础 stabilization ： bony anatomy surrounding muscles capsular structures Arthroscopy ANATOMY:STABILIZER GLENOHUMERAL JOINT：GLENOID FOSSA OF THE SCAPULA?+ HEAD OF THE HUMERUSLABRUM：“BUMPER”：DEEPEN AND ENLARGE THE GLENOID FOSSA?BICEPS TENDON ：IS ANCHORED AT THE SUPERIOR LABRUM，A HUMERAL HEAD DEPRESSOR JOINT CAPSULEGLENOHUMERAL LIGAMENTS ROTATOR CUFF MUSCLES: SUPRASPINATUS, INFRASPINATUS, SUBSCAPULARIS, AND TERES MINOR SHOULDER PROPLEM ＜40 years old： symptoms of overuse or instability ＞age 40 years：present more commonly with rotator cuff, impingement, inflammatory, or degenerative joint disease types of symptoms 年龄越大，不稳越少见 HISTORY Was it a traumatic, nontraumatic, or overuse injury？ When and how did the injury occur？ Is the patient’s complaint of pain, loss of motion, weakness, or inability to perform sports, activities of daily living, or work？ Is there pain at rest, only with activity, or while sleeping？ Are there any neurologic symptoms？ PE Observation Palpation Passive and active ROM Resistive testing rotator cuff tear: specialized PE Labrum : Catching, clicking, or popping Multidirectional instability: sulcus sign IMAGING Plain radiographs Magnetic resonance imaging DIFFERENTIAL DIAGNOSIS Degenerative arthritis Labral tear Biceps tendon pathology Adhesive capsulitis Rotator cuff tear Impingement Instability Acromioclavicular joint injury or arthritis Scapulothoracic dysfunction Cervical or neurologic Infection NONOPERATIVE MANAGEMENT Rest NSAIDS physical therapy diagnostic and therapeutic injections SURGICAL MANAGEMENT A patient who has failed to respond to nonoperative management and continues to have symptoms consistent with his or her diagnosis is a candidate for shoulder arthroscopy. PREOPERATIVE PLANNING Patient history and imaging studies are reviewed appropriate equipment and instruments An examination under anesthesia is performed to assess range of motion and stability. POSITIONING beach-chair position