肩关节疾病的诊断.ppt

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1、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AnatomyReviewShoulderGirdleAnatomyReviewBonyAnatomyScapulaClavicleAnatomyReviewBonyAnatomyHumerusRibsAnatomyReviewAnteriormusculatureoftheshouldergirdleAnatomyReviewMusculatureofposteriorshouldergirdleAnatomyReviewShoulder

2、ligamentsAnatomyReviewShoulderjointcapsuleandcartilageAnatomyReviewBloodSupplyandInterventionShoulderEvaluation(History)HistoryWhatisthecauseofpain?Mechanismofinjury?Previoushistory?Location,durationandintensityofpain?Creptitus,numbness,distortionintemperatureWeaknessorfatigue?Whatprovid

3、esrelief??ShoulderEvaluation(Observation)ElevationordepressionofshouldertipsPositionandshapeofclavicleAcromionprocessBicepsanddeltoidsymmetryPosturalassessment(kyphosis,lordosis,shoulders)PositionofheadandarmsScapularelevationandsymmetryScapularprotractionorwingingMusclesymmetryScapulohu

4、meralrhythmShoulderEvaluation(Observation)ScapulohumeralRhythmMovementofscapularelativetothehumerusInitial30degreesofglenohumeralabductiondoesnotincorporatescapularmotion(settingphase)30to90degreesthescapulaabductsandupwardlyrotates1degreeforevery2degreesofhumeralelevationAbove90degreest

5、hescapulaandhumerusmovein1:1ratioShoulderEvaluation(Palpation)BonyStructuresSternoclavicularjointClavicularshaftAcromioclavicularjointCoracoidprocessAcromionprocessHumeralheadGreaterandlessertuberosityBicipitalgrooveSpineofscapulaScapularvertebralborderScapularlateralborderScapularsuperi

6、orangleScapularinferiorangleShoulderEvaluation(Palpation)SoftTissuePalpationSternoclavicular,acromioclavicularandcoracoclavicularligamentsRotatorcuffmusclesandtendonsSubacromialbursaSternocleidomastoidBicepsandtendonCoracoacromialligamentGlenohumeraljointcapsuleDeltoidRhomboidsLatissimus

7、dorsiSerratusAnteriorLevatorscapulaeTrapeziusSupraspinatusInfraspinatusTeresmajorandminorShoulderEvaluation(SpecialTests)ActiveRangeofMotion(ROM)Flexion@180oExtension@50oAbduction@180oAdduction@40oInternalRotation@90oExternalRotation@90oManualMuscleTestingFivePointgrading