冻结肩一次治愈-发现新体征及其对诊断与治疗的意义

用手法松解治疗冻结肩152例。发现新体症:①腋前襞挛缩与上臂夹角变锐;②腋后襞挛缩,背阔肌变短;③肩关节外展肩峰与肱骨大结节间皮肤凹窝消失;④胸椎侧弯,⑤患侧手无名指掌指关节屈肌腱鞘结节样增厚,压痛明显。探讨了其对诊断及治疗的意义。     

冰结肩一次治愈——发现新体征及其对诊断与治疗的意义

用手法松解治疗冻结肩152例，发现新体征：1、腋前襞挛缩与上臂夹角变锐，2、腋后襞挛缩，背阔肌变短；3、肩关节外展肩峰与肱骨大结节间皮肤凹窝消失；4、胸椎侧弯，5、患侧手无名指掌指关节屈肌腱鞘结节样增厚，压痛明显，探讨了其对诊断及治疗的意义。     

252例冻结肩的临床治疗

冻结肩又称肩周炎、粘连性肩关节炎、五十肩等 ,是由于肩关节周围软组织病变而引起的肩关节疼痛和活动功能障碍。冻结肩多发于 40岁以上患者 ,女多于男 (约 3∶1) ,左肩多于右肩。我院 1996年以来对 2 5 2例冻结肩患者除采取提举松解法和宣氏手法松解肩周软组织外 ,还根据软组织外科无菌性炎症致痛理论和有关治痛的理论 ,辅以药物压痛点注射疗法 ,使冻结肩的治疗疗程缩短至 2周 ,且疗效显著 ,现报告如下。1　资料和方法1 1　一般资料　本组 2 5 2例 ,男 10 8例、女 144例 ,年龄 36～74岁 ,平均为 49.5岁。其中有外伤史 (含锁骨骨折、上肢骨…     

肩锁关节脱位的诊断与治疗

肩锁关节脱位是临床常见的肩部运动损伤。目前,临床认为RockwoodⅠ、Ⅱ型急性脱位应行非手术治疗,Ⅳ、V及Ⅵ型急性脱位应行手术治疗,但对Ⅲ型急性脱位是采取非手术治疗还是手术治疗仍存在争议。本文对肩锁关节脱位的治疗现状进行综述。     

关节镜下三联松解术结合肩袖修复治疗肩袖损伤合并冻结肩的疗效观察

目的 观察关节镜下三联松解术结合肩袖修复应用于肩袖损伤合并冻结肩患者的疗效。方法 选取2016年6月-2021年6月收治的肩袖损伤合并冻结肩患者60例,随机将其分为对照组和研究组,每组患者30例。对照组予以关节镜下三联松解术治疗,研究组予以关节镜下三联松解术结合肩袖修复治疗。比较两组临床指标、视觉模拟评分法(VAS)、肩关节评分(UCLA)、肩肘外科协会(ASES)评分、临床疗效。结果 研究组患者在术中、术后的临床指标及各项评分均优于对照组;并且研究组的治疗总有效率(93.33%)高于对照组(70.00%),差异突出(P<0.05)。结论 关节镜下三联松解术结合肩袖修复能促进肩袖损伤合并冻结肩患者康复,有效降低术中出血量,减少了患者疼痛感,具有较好的肩关节功能改善。     

肩周炎与肩袖损伤的MRI鉴别诊断在临床治疗中的意义

目的探讨MRI在鉴别诊断肩周炎与肩袖损伤病变的应用及帮助临床做出准确诊断、选择正确的治疗方法的研究价值。方法回顾性分析从2012年9月~2014年9月具有肩关节疼痛及运动功能障碍且经磁共振检查诊断为肩周炎或肩袖损伤的36名患者磁共振图像表现。结果 MRI诊断为肩周炎的患者11例,其中6例患者外用扶他林加理疗、推拿;5例患者采取局部注射得宝松1~3次。肩袖损伤25例,其中1级损伤5例,2级损伤16例,3级损伤4例。1级损伤采用保守治疗;2级损伤保守治疗3~6个月后,11例患者症状减轻或明显减轻,5例患者效果欠佳,采用手术治疗;3级损伤采用手术治疗。结论 MRI在鉴别诊断肩周炎与肩袖损伤病变的应用及帮助临床做出准确诊断、选择正确的治疗方法有确切的研究价值。     

温热磁场、超短波对中老年肩周炎的疗效观察

肩周炎俗称“五十肩”,多见于中年以上的人,是一种肩部常见病,目前尚无特殊的治疗方法。HM202温热磁场治疗仪借助于磁场、温热及微震三种效应治疗疾病,有可能成为治疗肩周炎的有效方法。作者用温热磁场、超短波治疗81例患者,取得了一定的效果,现报道如下。     

肩袖损伤的诊断和治疗进展

在肩关节病变中,肩袖损伤约占17%～41%?其主要表现为肩关节疼痛和严重的肩关节功能障碍?最早在1834年由Smith发现并命名,当时未被引起重视,直到1931年Codman和Akerson指出本病是引起肩疼的一个重要原因,并对其诊断和治疗作了初步的研究之后,近年来,许多作者开始探讨有关本病的诊断和治疗方法?1 病因学关于肩袖撕裂的病因有两种主要学说,一些学者认为冈上肌血管减少区随年龄增长退变增加,出现肌纤维组织坏死断裂,遇轻微外伤即可出现明显撕裂,是为退变外伤学说?而Neer则认为95%的肩袖撕裂是因撞击所引起,这是因为肩袖肌腱位于喙肩弓和肱骨大…     

关节镜下关节囊松解与臂丛麻醉下手法松解治疗冻结肩疗效对比分析

目的比较关节镜下松解与臂丛麻醉下手法松解治疗冻结肩的术后疗效。方法选取自2013年1月至2015年12月大连市第二人民医院收治的冻结肩患者50例为研究对象,采用机械抽样法将患者随机分为手法松解组(n=25)和关节镜组(n=25)。手法松解组采用臂丛麻醉下行手法松解,关节镜组采用关节镜下松解关节囊。观察并比较两组患者的住院及随访时间、肩关节活动度、肩关节Constant功能评分、疼痛视觉模拟评分(VAS)、治疗费用及并发症发生情况。结果两组患者的住院及随访时间比较,差异均无统计学意义(P>0.05);两组患者术前肩关节被动外展、前屈、后伸、外旋活动度比较差异无统计学意义(P>0.05);关节镜组患者术后肩关节被动外展、前屈、后伸、外旋活动度分别为(118.2°±11.2°)、(125.8°±8.4°)、(36.6°±3.7°)、(61.4°±6.0°),均优于手法松解组的(86.4°±6.0°)、(91.4°±8.5°)、(29.3°±5.8°)、(44.7°±7.0°),两组比较,差异有统计学意义(P<0.05)。关节镜组患者术后肩关节功能评分为(70.2±5.5)分,优于手法松解组的(54.0±6.3)分,两组比较,差异有统计学意义(P<0.05)。两组患者术后VAS评分比较,差异无统计学意义(P>0.05)。关节镜组治疗费用明显高于手法松解组,两组比较,差异有统计学意义(P<0.05)。两组患者均未出现术中并发症及术后肩关节不稳定,无术后神经损伤。结论肩关节镜下松解术治疗冻结肩在肩关节活动度和功能上的效果优于手法松解术,临床效果满意。     

超声引导下液压扩张联合松解手法治疗原发性冻结肩的临床研究

目的：评价超声实时引导下盂肱关节后隐窝入路液压扩张关节囊联合松解手法治疗原发性冻结肩的有效性及安全性。方法：选择原发性冻结肩患者75例（共80个患肩）为研究对象,随机分为试验组（35例,40个患肩）和对照组（40例,40个患肩）。试验组采用超声引导下盂肱关节后隐窝入路液压扩张关节囊联合手法松解治疗,对照组仅行超声引导下盂肱关节后隐窝入路液压扩张。患者治疗后4周分别采用视觉模拟量表（VAS）、Constant-Murley肩关节功能评分及美国加州大学洛杉矶分校（UCLA）肩关节功能评分评定治疗的有效性及安全性。结果：试验组治疗总有效率高于对照组（P<0.05）。治疗前,2组患者VAS评分、Constant-Murley评分及UCLA评分比较,差异均无统计学意义（均P> 0.05）。治疗后,2组肩关节VAS评分低于治疗前,且试验组低于对照组（均P<0.05）;治疗后Constant-Murley评分及UCLA评分均高于治疗前,且试验组均高于对照组（均P<0.05）。所有患者均在超声引导下一次性穿刺成功,治疗过程中均耐受,未发生明显不适及并发症。结论：超声引导下实时液...     

肱骨近端骨折两种方法治疗后冻结肩及干预措施

目的探讨肱骨近端骨折两种方法治疗后冻结肩情况以及干预方法。方法我院于2007年12月～2010年2月共收治64例肱骨近端骨折的患者,其中男30例,女34例,年龄23～96岁,平均54.1岁,肱骨近端锁定钢板手术治疗32例,保守治疗32例,按美国肩肘外科评分随访观察各病例肩关节恢复情况。结果 64例中30例出现不同程度冻结肩症状,肱骨近端骨折保守治疗与手术治疗以及同一治疗组内不同骨折类型之间评分有明显的差异（P〈0.05）。结论肱骨近端骨折出现冻结肩症状发生率高,治疗非常困难,需引起重视。     

Adhesive capsulitis of the shoulder: evaluation with MR arthrography

The purpose of this study was to determine the usefulness of magnetic resonance (MR) arthrography for diagnosing adhesive capsulitis. Shoulder MR images of 28 patients with (n=14) and without (n=14) adhesive capsulitis were retrospectively analyzed. MR images were assessed for capsule and synovium thickness as well as the width of the axillary recess on oblique coronal fat-suppressed T1-weighted images and T2-weighted images, respectively. On oblique sagittal fat-suppressed T1-weighted images, the width of the rotator interval and the presence of abnormal tissue in the interval were evaluated. Significant differences were found between the two groups in capsule and synovium thickness on both sides of the recess on oblique coronal T2-weighted images (P=0.000), whereas thickness on the humeral aspect showed no significant difference on oblique coronal fat-suppressed T1-weighted images (P=0.109). On oblique coronal T2-weighted images, a cut-off value of 3-mm thickness gave the highest diagnostic accuracy for adhesive capsulitis with sensitivity, specificity, and accuracy of 79% (11/14), 100% (14/14), and 89% (25/28) at the humeral side and 93% (13/14), 86% (12/14), and 89% (25/28) at the glenoid side, respectively. There were significant differences in rotator interval width, presence of abnormal tissue in the rotator interval, and axillary recess width between the two groups (P<0.05). Thickness of capsule and synovium of the axillary recess greater than 3 mm is a practical MR criterion for diagnosing adhesive capsulitis when measured on oblique coronal T2-weighted MR arthrography images without fat suppression. The presence of abnormal tissue in the rotator interval showed high sensitivity but rather low specificity.     

Idiopathic adhesive capsulitis of the shoulder: a review

Many terms have been used to describe what has been called idiopathic adhesive capsulitis of the shoulder. This pathology is defined as a self-limiting condition of unknown etiology. The natural history is 18–30 months even though a high-percentage of patient present impaired range of movement even at long-term follow-up. The diagnosis is mainly clinical and no significant changes are normally present at MRI or CT scan. Several treatment options have been tried over the years with different approaches and results.     

超声引导下注射治疗肩关节周围滑囊炎的疗效观察

目的探讨超声引导下及解剖定位下药物注射治疗肩关节周围滑囊炎的临床效果。方法选取2015年8月至2018年12月期间在我院接受治疗的224例肩关节周围滑囊炎患者,随机分成对照组与研究组,每组112例。每组患者均进行常规的推拿理疗、手法松解,在此基础上,观察组行超声引导下药物注射治疗,对照组在解剖定位下行注射治疗。然后,比较2组患者肩关节的活动度、肩关节功能量表(Constant Murley)的评分以及视觉模拟量表(VAS)的评分。结果治疗后,观察组患者肩关节的上举、后伸、外展的角度明显高于对照组,内收的角度明显低于对照组,差异有统计学意义(P<0.05),观察组患者的Constant Murley评分高于对照组患者,VAS评分低于对照组患者,差异有统计学意义(P<0.05)。结论超声引导下注射治疗肩关节周围滑囊炎具有较好的临床疗效,安全性高,适宜推广。     

Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment

Shoulder pain and dysfunction is a complex problem frequently encountered by primary care physicians. Common nonarthritic conditions seen in the primary care setting include rotator cuff syndrome, impingement, posttraumatic stiffness, adhesive capsulitis, and instability. A thorough history and physical examination can aid in the diagnosis of many common shoulder complaints. Pain and instability are the most common shoulder complaints. Pain that is sharp or burning is commonly radicular in origin, whereas pain caused by tendinitis is often dull, diffuse, and aching. Instability is frequently found in patients with a history of dislocation, but also may occur with no prior history. Imaging modalities such as magnetic resonance imaging can be helpful for more advanced pathology. However, many common shoulder conditions can be diagnosed without imaging, and may be initially treated with a short course of rest, ice, topical analgesics, nonsteroidal anti-inflammatory drugs, directed and supervised physical therapy, and occasionally subacromial corticosteroid injections. As always, a detailed history and a thorough physical exam by a primary care physician are vital for diagnosis. When conservative measures fail, referral to an orthopaedic surgeon may be necessary for further patient management.     

偏瘫性肩痛患者腋囊的MRI观测及临床意义

目的通过MRI技术观察偏瘫患者肩疼痛腋囊形态变化,为影像诊断提供依据。方法对47例偏瘫性肩疼痛患者(疼痛组)和47例正常肩部(对照组),运用MRI技术对肩关节腋囊进行测量,观察腋囊下肱盂韧带信号。结果偏瘫性肩疼痛的腋囊厚度(4.1±1.45)mm,高于对照组。腋囊腔高度(8.70±1.80)mm,腋囊腔宽度(4.31±0.56)mm,小于对照组。偏瘫性肩痛下肱盂韧带呈高信号出现率达21%,腋囊厚度与VAS呈正相关,与肩关节外展外旋呈负相关。结论脑中风中后期肩周炎是引起偏瘫性肩疼痛患者的常见原因,腋囊厚度是限制肩关节活动度的重要因素。     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折手术入路的选择及分析临床应用效果。方法从1997年7月—2009年1月对31例肩胛骨骨折患者采用三种不同的手术入路进行内固定,对比其临床适应证,分析治疗效果。结果 31例患者全部得到随访,按照Constant的评定标准:优22例,良6例,可3例,优良率为90.3%。结论肩胛骨骨折通过手术治疗可获得良好的疗效,不同的骨折类型应采用不同手术入路,可获得更好的治疗效果。     

MRI of adhesive capsulitis of the shoulder: Distension of the bursa in the superior subscapularis recess is a suggestive sign of the pathology

Objective

To evaluate the diagnostic values of the superior subscapularis recess sign in patients with shoulder adhesive capsulitis. The sign consists in evaluating in MRI of the shoulder the presence of fluid distension of the bursa in the superior subscapularis recess.

Materials and methods

We evaluated MRI of 165 shoulders in 48 consecutive patients with a diagnosis of shoulder adhesive capsulitis in the freezing phase (group I), in 49 short-wide superior cuff tear (group II) and in 65 controls (group III) between 2010 and 2013. On the T2 weighted images, we evaluated the presence of an high intensity signal within the superior subscapularis recess, consistent with fluid distension of the bursa.

Results

The sign was found in 43/48 patients (89.58%) with shoulder adhesive capsulitis in 3/49 (6.12%) patients with superior cuff tear and in 1/65 controls (1.53%) (p < 0.001). The mean diagnostic values were: sensibility 0.91; specificity 0.96–0.98; positive predictive value 0.93–0.97; negative predictive value 0.92–0.94; likelihood ratios for an abnormal test result 15.16–60.6; likelihood ratios for a normal test result 0.086–0.095.

Conclusion

For the orthopedic surgeon or the clinician, the sign is useful to confirm in MRI the clinical diagnosis of shoulder adhesive capsulitis; accordingly, the radiologist should describe and relate this sign to the pathology in the report, looking eventually for further typical sign of shoulder adhesive capsulitis.     

Monopolar electrothermal arthroscopy for treatment of shoulder instability in the athlete

Arthroscopic stabilization of the shoulder has gained considerable interest as a treatment alternative for shoulder instability in athletes. Basic science and clinical studies are helping to define the ideal patient population, surgical techniques, and rehabilitation protocols that will enhance our surgical results and maximize patient satisfaction. We describe here our surgical program, basic science foundation, and early clinical results.[/]ab     

Arthroscopy of the shoulder

Arthroscopy of the shoulder has developed during the last decade to play a major role in diagnoses and treatment of a variety of shoulder disorders. In most incidences, arthroscopy is required at the time of shoulder surgery to refine the final diagnosis. In over 75% of the cases are arthroscopic methods used for surgical repair of the shoulder pathology. This article describes the indications for surgery as well as the techniques to treat rotator cuff disease label injuries, etc. with the arthroscope. The arthroscopic techniques dealing with subacromial decompression and instability is described.