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1、持續醫學進修專訊Throwers’Shoulder:January2007ACriticalReviewofItsProblems二零零七年一月andCurrentManagement–PartIIDr.KONGKamFuJamesSpecialistinOrthopaedics&TraumatologyM.B.,B.S.(HK),M.Sc.(Ex&SportsMed)(Bath),F.C.S.H.K.,F.R.C.S.Ed,F.R.C.S.Ed(Orth),F.H.K.C.O.S.,F.H.K.A.M.(O
2、rth)DiagnosisAsystematicapproachofinspection,palpation,Totreatsuccessfullythepainfulshoulderinrangeofmotion,andthrowers,thedoctorneedstotakeadetailedneuromusculartestinghistory,performathoroughphysicalexamination4shouldbeperformed.Onandusespecialstudiesprud
3、ently.inspection,throwersoftenposturewiththeirTheinterviewshouldbeginwiththedocumentationshoulderforwardanddownincomparisonwithofthechiefcomplaint.Painisthemostcommontheirnonthrowingside.Muscularhypertrophyisreasonforpresentation.Thephysicianshould,usuallyn
4、otedandbestseenalongthedeltoidandduringtheinterview,trytoestablishtheonset,infraspinatusfossa.Atrophyintheareaisimportantlocationanddurationofthepain.Itisalsousefulinrotatorcuffdiseaseoritmayberelatedtotoaskthethrowertodemonstrateatwhatphasesuprascapularner
5、veinnervation.heexperiencesthepain.Furtherquestioningofotherinjuriesisalsoimportant.FaultybiomechanicsThepositionofscapularonthethoraxwiththeoflowbackandextremityinjuriesmayaffectthe4,43serratusanteriorortrapeziusisimportant.Wingingshoulder.ofthescapularcan
6、indicateproblemswiththeserratusanteriorortrapezius,itsmajorstabilizers.Throwersoftenexperiencestiffness,catching,Awallpushuptestcanbeusedtoassessscapulaclickingorradicularsymptoms.Theseareoftenmusclecontrol.Theparascapularmusclescanbesecondarycomplaintsbutc
7、anbethereasonforpalpatedduringtheconcentricandeccentricreferral.Stiffnessisoftennotedwhenasorecontraction.58shoulderispresent.Again,thestiffnessmaybeassociatedwithfatigue.CatchingandclickingisPalpationoftheshouldershouldbedoneinoftenlocatedwithinthesubacrom
8、ialbursaeorregions.Pressurealongtheclavicleishelpfulinwithinthejoint.Whenitisassociatedwithpain,establishingthepresenceofpaininthetruepathologyexists.Apainfulclickcanbefoundsternoclavicularandacromiocl
