1、肩关节疾病的诊断肱二头肌间沟肱二头肌腱岗上肌滑囊和盂唇肩峰前外角下方约 2cmROM 前屈外展上抬 00 1800Stage 4:no evidence of synovitis tight inferior fold and joint病程分期Bursal SideNeer提出肩关节在运动的过程中有一些结构性因素和动力性因素与肩峰发生摩擦产生病理性疼痛Radiology normal肩关节检查压疼点(Palpation)冻结肩冻结肩Stages of Calcifying Tendinitis:Uthoffs ClassificationPure impingement with no in
2、stability?韧带结构Radiological staging of Calcifying Tendinitis:Gartner and Heyer Classification慢性损伤 年龄（退变）Stages of Calcifying Tendinitis:Uthoffs ClassificationA2 Marked scuffing/damage of the undersurface of the acromion&CA ligament韧带结构Stiffness:412 monthsTeres major and minor避免做可能使肩关节疼痛的动作Stage 2 Bur
3、sal thickness over 2.手术指征 规范保守治疗无效主要是累计岗上肌、岗下肌、肩胛下肌Radiological morphology of Calcifying Tendinitis:Mol Classification(1993)影像学没有明确的阳性改变历史 1896年Duplay提出 pereglanoiolitis 盂肱关节周围炎 首次医学描述肩僵硬岗下肌 Leg 症手术选择 关节镜下肩峰成型术病因 体内钙的代谢紊乱A2 Marked scuffing/damage of the undersurface of the acromion&CA ligament二头肌在盂唇
4、损伤的病理作用Acromial Side Bursal SideSubacromial Impingement classifications影像学没有明确的阳性改变B1 Minor scuffing,haemorrhage or local injection and inflammation过度使用影像学没有明确的阳性改变肩关节功能逐渐丧失 给临床带来混乱肩峰前外角下方约 2cm肌腱炎 滑囊炎Primary instability with capsular and labral injury with secondary impingement which can be internal
5、 impingement or subacromialA calcification dense homogenous with clear contoursA2 Marked scuffing/damage of the undersurface of the acromion&CA ligamentRadiological morphology of Calcifying Tendinitis:Mol Classification(1993)发病率 白种人较高 黄种人低肩峰前外角下方约 2cmFrozen shoulder:Lundberg classification全方位功能受限Acr
6、omion process结构性因素 肩峰的形态 肌腱的炎性退变增粗 滑囊炎容积增大 大结节骨折肩峰前外角下方约 2cm肱骨头与喙肩弓持续撞击肩周炎的概念Subacromial Impingement classificationsLatissimus dorsiA1 Minor scuffing,haemorrhage or local injection and inflammationGrading of impingement changes:Milgroms ultrasound classificationStage 2:fibrosis and tendinitis,age 25
7、40,recurrent pain with activityShoulder joint capsule and cartilage肱二头肌间沟肱二头肌腱Bursal SideRadiological morphology of Calcifying Tendinitis:Mol Classification(1993)撞击的病理Stage 2:fibrosis and tendinitis,age 2540,recurrent pain with activity肌腱炎 滑囊炎Primary instability because of generalised ligamentous la
8、xity with secondary impingement过度使用Bursal Side影像学没有明确的阳性改变解冻期 后期 5个月至2年 疼痛减轻功能恢复肱二头肌间沟肱二头肌腱肌腱炎 滑囊炎Bony Anatomy肩关节检查压疼点(Palpation)影像学评估l0 Normal-smooth surface A1 Minor scuffing,haemorrhage or local injection and inflammation Acromial SidelA1 Minor scuffing,haemorrhage or local injection and inflamma
9、tionBare bone areasA3 B0 Normal-smooth surfaceB1 Minor scuffing,haemorrhage or local injection and inflammation Bursal SideB0 Normal-smooth surfaceB3 Full thickness tearB4 Massive cuff tearStages of Calcifying Tendinitis:Uhthoffs Classification避免做可能使肩关节疼痛的动作肩周炎是垃圾箱 弃用Five Point grading systemB1 Mino
10、r scuffing,haemorrhage or local injection and inflammation肩峰前外角下方约 2cmLimitation of movement only at glenohumeral articulationScapulohumeral rhythmStage 3:Pink synovium contracted inferior fold,tight joint space4=Complete ROM against gravity,with some resistance肱骨与肩胛骨的运动关系Primary instability with ca
11、psular and labral injury with secondary impingement which can be internal impingement or subacromialStiffness:412 months肩关节特殊检查(Special Tests)冻结期 中期 32个月 关节僵硬Other causes ie trauma,OA,RA,Hemiplegia etc excludedAcromial Side Bursal Side肱二头肌间沟肱二头肌腱Subacromial Impingement classificationsAcromion processB1 Minor scuffing,haemorrhage or local injection and inflammationLarge 1.Latissimus dorsiA3 Bare bone areas
