肩袖损伤

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,肩袖损伤,(snshng),第一页，共四十四页。,肩袖损伤,(snshng),的流行病学,Uhthoff et al.1 found a 20%prevalence in a series of cadaver dissections in which the mean age of the donors was 59.4 years.,Lehman et al.2 found a prevalence of 17%in a large series of cadaver dissections,with a prevalence of 30%in donors older than sixty years of age.,The incidence of full-thickness tears of the rotator cuff,ranges from 5%to 40%.Furthermore,epidemiological,studies show an increasing frequency of rotator cuff failure with advancing age3.,1 Uhthoff HK,Loehr J,Sarkar K.The pathogenesis of rotator cuff tears.In:Takagishi N,editor.The shoulder.Tokyo:Professional PostGraduate Services;1987:211-2.,2 Lehman C,Cuomo F,Kummer FJ,Zuckerman JD.The incidence of full thickness rotator cuff tears in a large cadaveric population.Bull Hosp Jt Dis.1995;54(1):30-1.,3 Bigliani LU,Morrison DS.Relationship between acromial morphology and rotator cuff tears.Orthop Trans.1986;10:216.,第二页，共四十四页。,当我们在临床上遇到疑似病人，只有,X,片而无,MRI,检查时，,1,我们能从,X,片中得到,(d do),什么信息？,2,我们印象中的可疑诊断有哪些？,3,针对性的体查有哪些？,第三页，共四十四页。,Gazzola S,Bleakney RR.Current imaging of the rotator cuffJ.Sports Med Arthrosc,2011,19(3):300-9.,cystic change of the greater tuberosity,1,读,X,片,第四页，共四十四页。,Gazzola S,Bleakney RR.Current imaging of the rotator cuffJ.Sports Med Arthrosc,2011,19(3):300-9.,normal subacromial joint space(7mm)(arrow),1,superior subluxation of the humeral head,(arrow),2 notched humeral neck(arrowhead),第五页，共四十四页。,Type I calcication with a uffy,eecy appearance with poorly dened borders,with acute symptoms and termed the resorptive phase.,Type II calcication,more discreet and of homogenous density,with well-circumscribed borders,and in the formative phase.,DePalma AF,Kruper JS.Long-term study of shoulder joints affliated with and treated for calcic tendinitisJ.Clin Orthop.1961;20:61-72.,calcic tendinopathy,第六页，共四十四页。,2,可疑,(ky),诊断,1,关于肩周炎 肩周炎,=,冻结,(dngji),肩（,实用骨科学,第,3,版），是由于肩关节周围软组织病变而引起肩关节疼痛和活动功能障碍。,国外报道,Frozen shoulder 40-60 years of age,incidence 2-5%1.,3 phases2,freezing phase,2-9 months,pain and loss of motion of the glenohumeral joint in all direction,，,usually worst at night and when lying on the affected side,2),frozen phase,4-12 months,stiffness reaches its maximum,thawing phase,5-12 months,range of motion returns to normal,2,肩峰下撞击综合症 疼痛，主诉为三角肌下疼痛，并经常向下放射至前方的肱二头肌，夜间疼痛可影响睡眠,1 Hand C,Clipsham K,Rees JL,et al.Long-term outcome of frozen shoulder.J Shoulder Elbow Surg 2008;17:231-6.,2 Reeves B.The natural history of the frozen shoulder syndrome.Scand J Rheumatol 1975;4:193-6.,第七页，共四十四页。,3,针对肩袖损伤,(snshng),的体查,1,冈上肌 肩外展功能,(gngnng),1 empty can test,1)90 degrees abduction,2)30 degrees horizontal abduction(in the plane of the scapula),3)thumbs pointing downward,第八页，共四十四页。,2 full can test,1)90 degrees in the horizontal plane,2)rotated 45degrees externally,3)with the thumb pointing upward,第九页，共四十四页。,painful arc test,60-120,1)shoulder in external rotation,2)palm facing up,第十页，共四十四页。,4,resistedisometricabduction,1)thearminneutralrotation,2)abductsthearmto90degrees,第十,一,一页,，,，共,四,四十,四,四页,。,。,1externalrotationstrengthtest=Pattestest,1)thepatient,selbowin90degrees,2)intheplaneofthescapula,2,冈下,肌,肌和,小,小圆,肌,肌,肩,肩外,旋,旋功,能,能,(g,ngn,ng),第十,二,二页,，,，共,四,四十,四,四页,。,。,2externalrotationlagsign,1)elbowpassivelyflexedto90degrees,2)maximalexternalrotation,第十,三,三页,，,，共,四,四十,四,四页,。,。,3dropsign,1)almostfullexternalrotation,2)elbowflexedat90degrees,第十,四,四页,，,，共,四,四十,四,四页,。,。,4weaknesswithexternalrotation,1)elbowsflexedto90degrees,2)thethumbsup,3)shouldersrotatedinternally20degrees,第十,五,五页,，,，共,四,四十,四,四页,。,。,3,肩胛,(jinji),下肌,肩,肩,内,内旋,、,、后,伸,伸功,能,能,1liftofftest,askingthepatienttointernallyrotatethearmtoliftthehandposteriorlyoffoftheback,第十,六,六页,，,，共,四,四十,四,四页,。,。,2,internalrotationlagsign,第十,七,七页,，,，共,四,四十,四,四页,。,。,3bellypress,第十,八,八页,，,，共,四,四十,四,四页,。,。,4bearhugtest,第十,九,九页,，,，共,四,四十,四,四页,。,。,4,针对,(zhndu),肩峰,下,下撞,击,击综,合,合症,的,的体,查,查,第二,十,十页,，,，共,四,四十,四,四页,。,。,Hawkins-Kennedytest,第二,十,十一,页,页，,共,共四,十,十四,页,页。,关于,(guny,),MRI,肩袖,解,解剖,(jipu),第二,十,十二,页,页，,共,共四,十,十四,页,页。,解剖,(jipu),足印,（,（,footprint,）,第二,十,十三,页,页，,共,共四,十,十四,页,页。,关于,(guny,),MRI,正常,(zhngch,ng),肩袖,的,的,MRI,斜冠,状,状面,第二,十,十四,页,页，,共,共四,十,十四,页,页。,正常,(zhngch,ng),肩袖,的,的,MRI,斜矢,状,状面,第二,十,十五,页,页，,共,共四,十,十四,页,页。,正常,(zhngch,ng),肩袖,的,的,MRI,横断,面,面,第二,十,十六,页,页，,共,共四,十,十四,页,页。,损伤,(s,nsh,ng),肩袖,的,的,MRI,第二,十,十七,页,页，,共,共四,十,十四,页,页。,魔法,(m,f),角,magicanglephenomenon,thefibersareat55degreestothemainmagneticfieldonT1,EricksonSJ,ProstRW,TiminsME.The,“,“magicangle,”,”effect:backgroundphysicsandclinicalrelevance.Radiology.1993;188:23-25.,第二,十,十八,页,页，,共,共四,十,十四,页,页。,我们,(w,men),在,MRI,上应,得,得到,的,的信,息,息,1,肩袖,走,走行,及,及连,续,续性,2,高信,号,号,(x,nho),3,脂肪,变,变性,4,肌肉,萎,萎缩,5,肌肉,回,回缩,6,三角,肌,肌下,、,、肩,峰,峰下,囊,囊滑,液,液相,连,连,第二,十,十九,页,页，,共,共四,十,十四,页,页。,肩袖,走,走行,及,及连,续,续性,第三,十,十页,，,，共,四,四十,四,