肩關(guān)節(jié)的臨床檢查方法課件

肩關(guān)節(jié)的臨床檢查方法

Clinicaltestsinshoulderexamination:howto

performthem肩關(guān)節(jié)的臨床檢查方法

Clinicaltestsins1

Background

Theshoulderisoftenconsideredadifficultjointtoexamine,andthisispartlyduetothelargenumberofdifferentclinicaltestsofshoulderfunction.肩關(guān)節(jié)通常被認(rèn)為是一種很難檢查的關(guān)節(jié)，在一定程度上是因?yàn)榕R床上肩關(guān)節(jié)功能的檢查方法較多。Thecommonestshoulderinjuriesinclude:impingement,rotatorcuffinjuries,labraltears,instabilityandacromioclaviculardysfunction.常見的肩關(guān)節(jié)損傷包括：肩峰撞擊綜合征、肩袖的損傷、盂唇的損傷、肩關(guān)節(jié)的不穩(wěn)定性以及肩鎖關(guān)節(jié)的功能障礙。Background

Theshoulderiso2

Theshoulder盂肱關(guān)節(jié)

glenohumeraljoint肩鎖關(guān)節(jié)

acromioclavicularjoint胸鎖關(guān)節(jié)sternoclavicularjoint

肩肱關(guān)節(jié)（肩胛下間隙）

subacromiclspace肩胛胸廓關(guān)節(jié)Scapularthoracicjoint也有將喙鎖間聯(lián)系稱為喙鎖關(guān)節(jié)CoracoclavicularjointTheshoulder盂肱關(guān)節(jié)glenohumer3盂肱關(guān)節(jié)glenohumeraljoint肱骨頭humeralhead盂窩glenoidcavity盂唇glenoidlabrum關(guān)節(jié)囊articularcapsule韌帶ligament支持結(jié)構(gòu)supportingstructure盂肱關(guān)節(jié)glenohumeraljoint肱骨頭hume4盂肱關(guān)節(jié)glenohumeraljoint關(guān)節(jié)盂關(guān)節(jié)囊articularcapsulethinandlax,luxateinthefront

andbottom盂肱關(guān)節(jié)glenohumeraljoint關(guān)節(jié)盂關(guān)節(jié)囊a5肩鎖關(guān)節(jié)acromioclavicularjoint肩鎖韌帶Acromioclavicularlig.喙鎖韌帶Coracoclavicularlig.斜方韌帶Trapezoidlig.錐狀韌帶Conoidlig.肩鎖關(guān)節(jié)acromioclavicularjoint肩鎖韌6

胸鎖關(guān)節(jié)sternoclavicularjoint

鞍狀關(guān)節(jié)sellarjiont韌帶組織ligament

胸鎖前韌帶胸鎖后韌帶胸鎖上韌帶鎖間韌帶肋鎖韌帶關(guān)節(jié)盤articulardisc胸鎖關(guān)節(jié)sternoclavicularjoint

7肩胛下間隙subacromicalspace肱骨頭與喙肩韌帶之間humeralhead,Coracoacromiallig.肩峰acromion喙肩韌帶Coracoacromiallig.喙突coracoidprocess肩鎖關(guān)節(jié)acromioclavicularjoint內(nèi)容物：肩峰下滑囊subacromicalbursa肩袖rotatorcuff二頭肌長頭腱tendonoflongheadofbicepsbrachii肩胛下間隙subacromicalspace肱骨頭與喙肩韌8肩袖

rotatorcuff肩胛下?。簝?nèi)收、旋內(nèi)Subscapularis:adduction,medialrotation岡上?。和庹筍upraspinatus:abduction岡下肌：旋外Infraspinatus:externalrotation小圓肌：旋外Teresminor:externalrotation肩袖rotatorcuff肩胛下?。簝?nèi)收、旋內(nèi)9ContentThisarticlewilldescribethebestclinicalshouldertestsasratedinthissystematicreviewandmeta-analysisoftheindividualtests.這篇文章描述了在綜述中被評估為最好的臨床上的肩關(guān)節(jié)的檢查方法。ContentThisarticlewilldescr10TestImpingementtests撞擊試驗(yàn)Rotatorcufftests肩袖試驗(yàn)SuperiorlabrumanteriortoposteriorlesionstestsSLAP損傷試驗(yàn)Instabilitytests不穩(wěn)定試驗(yàn)Acromioclaviculartests肩鎖關(guān)節(jié)試驗(yàn)TestImpingementtests撞擊試驗(yàn)11撞擊試驗(yàn)Neer征(篩查screen)Hawkins–Kennedy試驗(yàn)(篩查screen)空罐試驗(yàn)（確診confirm）撞擊試驗(yàn)Neer征(篩查screen)12撞擊試驗(yàn)

Neer征

陽性：肩部疼痛注射10ml的利多卡因來緩解疼痛

inject10mloflidocaine意義：肱骨大結(jié)節(jié)撞擊發(fā)生炎性的岡上肌以及肩峰下滑囊Thetuberculummajusimpingesthedegeneratedsupraspinatusandsubacromialbursaagainsttheacromion

撞擊試驗(yàn)

Neer征13Hawkins–Kennedy試驗(yàn)陽性：被動(dòng)內(nèi)旋導(dǎo)致疼痛

painwithforcedinternalrotation

意義：肱骨大結(jié)節(jié)促使岡上肌肌腱撞擊韌帶ThetuberculummajusforcesthesupraspinatustendonagainstthecoracoacromialeligamentHawkins–Kennedy試驗(yàn)14空罐試驗(yàn)Emptycantest

陽性：肩部疼痛意義：岡上肌的強(qiáng)度測試。肩胛下肌、岡下肌和小圓肌的電位相對不變。Strengthtestofthesupraspinatusmuscle.Thesubscapularis,infraspinatusandteresminorareelectricallycomparativelysilentinthisposition.空罐試驗(yàn)Emptycantest15Rotatorcufftests

肩袖試驗(yàn)外旋減弱征Externalrotationlagsign落臂征Droparmtest（假陽性）仰臥撞擊試驗(yàn)Supineimpingementtest腹部按壓試驗(yàn)BellypresstestRotatorcufftests

肩袖試驗(yàn)外旋減弱征E16Rotatorcufftests

肩袖試驗(yàn)

外旋減弱征

Externalrotationlagsign陽性：手臂掉落anangulardropoccur意義：手臂下落＞5°提示岡上肌腱或者岡下肌腱的局部撕脫Alagsignofmorethan5°isa(partial)tearoftheinfraspinatusorsupraspinatustendons.Rotatorcufftests

肩袖試驗(yàn)

外旋減弱征17落臂征Droparmtest陽性：患者身體可能會(huì)偏向受影響的一側(cè)，并且會(huì)突然縮短兩臂的伸展長度。

Thepatientmayleantotheaffectedsideandmaylowerthewholearmquitesuddenlyinabduction.意義：評定岡上肌和岡下肌的損傷

Thistestisdesignedforthe

assessment

ofsupraspinatusandinfraspinatusinjuries落臂征Droparmtest18仰臥撞擊試驗(yàn)

Supineimpingementtest陽性：疼痛的增加anincreasepain意義：評定肩袖損傷。疼痛可能是由于肩峰下間隙狹窄和加壓造成的。Assessanyrotatorcufftear.Painresultsfromnarrowingandcompressingthesubacromailspace.仰臥撞擊試驗(yàn)19腹部按壓試驗(yàn)

Bellypresstest陽性：患者不能保持肩關(guān)節(jié)最大限度的內(nèi)旋。肘關(guān)節(jié)向后移動(dòng)，肩內(nèi)旋消失。

Thepatientcan’tmaintainmaximalinternalrotation.Theelbowdropsbackwards,andinternalrotationislost意義：評定肩內(nèi)旋活動(dòng)度的減小Assessdecreasedinternalrotation.腹部按壓試驗(yàn)20

Superiorlabrumanteriortoposteriorlesionstests

SLAP損傷試驗(yàn)前方滑動(dòng)試驗(yàn)Anteriorslidetest（確診）肱二頭肌負(fù)重Ⅱ試驗(yàn)BicepsloadIItest（確診）

Superiorlabrumanteriorto21

前方滑動(dòng)試驗(yàn)Anteriorslidetest陽性：肩的疼痛或聲響

painoraclickinthefrontoftheshoulder意義：肱骨頭前后的運(yùn)動(dòng)會(huì)對上盂唇產(chǎn)生壓力。肱骨頭前方的運(yùn)動(dòng)也會(huì)導(dǎo)致肱二頭肌腱的牽伸，最終導(dǎo)致上唇復(fù)合體的伸展。Anteriorandsuperiorhumeralheadtranslationsallowstresstothesuperiorlabrum.Theupwardmotionalsocausestractiononthebicepstendon,stretchingthelabralcomplex.前方滑動(dòng)試驗(yàn)Anteriorslidetes22

肱二頭肌負(fù)重Ⅱ試驗(yàn)

BicepsloadIItest陽性：疼痛或加重的疼痛painormorepain意義：上盂唇從關(guān)節(jié)窩邊緣的剝落和疼痛的加重Thesuperiorlabrumispeeledoftheglenoidmarginandpainincreases.肱二頭肌負(fù)重Ⅱ試驗(yàn)BicepsloadIIte23不穩(wěn)定試驗(yàn)Instabilitytests恐懼試驗(yàn)Apprehensiontest再復(fù)位試驗(yàn)Relocationtest前方釋放試驗(yàn)Anteriorreleasetest不穩(wěn)定試驗(yàn)Instabilitytests恐懼試驗(yàn)App24恐懼試驗(yàn)

Apprehensiontest陽性：肩關(guān)節(jié)突然的恐懼感和疼痛Thereisasuddenapprehensionfeelingintheshoulderandpain.意義：組合的運(yùn)動(dòng)和向前的直接壓力會(huì)導(dǎo)致肩關(guān)節(jié)半脫位。Thecombinedmotionandanteriordirectedpressurecausessubluxationoftheshoulder.恐懼試驗(yàn)Apprehensiontest25

再復(fù)位試驗(yàn)Relocationtest陽性：疼痛的減輕，患者能夠忍受的最大的肩外旋位置Thereisareliefofpainandthepatientisabletotoleratemaximalexternalrotation.意義：向后的力把肱骨頭固定在適當(dāng)?shù)奈恢蒙蟃heposteriordirectedforcemaintainsthehumeralheadinposition.再復(fù)位試驗(yàn)Relocationtest26

前方釋放試驗(yàn)Anteriorreleasetest陽性：疼痛/疼痛加劇

Thereisasuddenpain/anincreaseinpain.意義：釋放后加的力量后，肱骨頭向前方半脫位

Releasingtheposteriorlydirectedforce,thehumeralheadcansubluxateanteriorly.前方釋放試驗(yàn)Anteriorreleasetest27Acromioclaviculartests

肩鎖關(guān)節(jié)試驗(yàn)O’Brien試驗(yàn)（確診）肩鎖關(guān)節(jié)壓痛試驗(yàn)ACjointtendernesstest（篩查）Acromioclaviculartests

肩鎖關(guān)節(jié)試驗(yàn)28O’Brien試驗(yàn)陽性：肩鎖關(guān)節(jié)周圍的疼痛更多的表現(xiàn)在抵抗內(nèi)旋上Thereisapainaroundtheacromioclavicular(AC)joint,morepresentwithresistedinternalrotation意義：肱骨大結(jié)節(jié)擠推肩峰使肩鎖關(guān)節(jié)受壓Theacromionispushedbythetuberculummajus,compressingtheACjointO’Brien試驗(yàn)29

肩鎖關(guān)節(jié)壓痛試驗(yàn)ACjointtendernesstest陽性：疼痛肩鎖關(guān)節(jié)壓痛試驗(yàn)30Mygains學(xué)習(xí)并掌握了多種有效的臨床肩關(guān)節(jié)檢查方法；Welearnandmastermanyeffectiveclinicalshoulderjointinspectionmethods2.在今后的學(xué)習(xí)中，要側(cè)重對于學(xué)習(xí)的概括；Inthefuture,wewillfocusonlearninggeneralization;3.臨床檢查中要重視個(gè)體化檢查以得到正確有效的結(jié)果。Weshouldpayattentiontotheindividualchecktogetcorrectresultsintheclinicalexamination.Mygains學(xué)習(xí)并掌握了多種有效的臨床肩關(guān)節(jié)檢查方法；31Advantages文章結(jié)構(gòu)清晰，圖文并茂，一目了然；

Thisarticlehasclearstructureandphotographsoftheexacttestprocedure;2.文章研究方向明確，對怎樣執(zhí)行肩關(guān)節(jié)臨床檢查做了一個(gè)實(shí)用性概括，很有目的性和針對性；

Thisarticlehasaclearstudyingdirectiononhowtocarryouttheclinicalshoulderjointexaminationanddoapracticalsummary,thisisobjectiveandtargeted;3.為未來檢驗(yàn)肩關(guān)節(jié)測試的可靠性與有效性引導(dǎo)了方向。Thisarticleguidesthedirectionofinspectingthereliabilityandvalidityofshouldertest.Advantages文章結(jié)構(gòu)清晰，圖文并茂，一目了然；32THANKYOU!THANKYOU!33肩關(guān)節(jié)的臨床檢查方法

Clinicaltestsinshoulderexamination:howto

performthem肩關(guān)節(jié)的臨床檢查方法

Clinicaltestsins34

Background

Theshoulderisoftenconsideredadifficultjointtoexamine,andthisispartlyduetothelargenumberofdifferentclinicaltestsofshoulderfunction.肩關(guān)節(jié)通常被認(rèn)為是一種很難檢查的關(guān)節(jié)，在一定程度上是因?yàn)榕R床上肩關(guān)節(jié)功能的檢查方法較多。Thecommonestshoulderinjuriesinclude:impingement,rotatorcuffinjuries,labraltears,instabilityandacromioclaviculardysfunction.常見的肩關(guān)節(jié)損傷包括：肩峰撞擊綜合征、肩袖的損傷、盂唇的損傷、肩關(guān)節(jié)的不穩(wěn)定性以及肩鎖關(guān)節(jié)的功能障礙。Background

Theshoulderiso35

Theshoulder盂肱關(guān)節(jié)

glenohumeraljoint肩鎖關(guān)節(jié)

acromioclavicularjoint胸鎖關(guān)節(jié)sternoclavicularjoint

肩肱關(guān)節(jié)（肩胛下間隙）

subacromiclspace肩胛胸廓關(guān)節(jié)Scapularthoracicjoint也有將喙鎖間聯(lián)系稱為喙鎖關(guān)節(jié)CoracoclavicularjointTheshoulder盂肱關(guān)節(jié)glenohumer36盂肱關(guān)節(jié)glenohumeraljoint肱骨頭humeralhead盂窩glenoidcavity盂唇glenoidlabrum關(guān)節(jié)囊articularcapsule韌帶ligament支持結(jié)構(gòu)supportingstructure盂肱關(guān)節(jié)glenohumeraljoint肱骨頭hume37盂肱關(guān)節(jié)glenohumeraljoint關(guān)節(jié)盂關(guān)節(jié)囊articularcapsulethinandlax,luxateinthefront

andbottom盂肱關(guān)節(jié)glenohumeraljoint關(guān)節(jié)盂關(guān)節(jié)囊a38肩鎖關(guān)節(jié)acromioclavicularjoint肩鎖韌帶Acromioclavicularlig.喙鎖韌帶Coracoclavicularlig.斜方韌帶Trapezoidlig.錐狀韌帶Conoidlig.肩鎖關(guān)節(jié)acromioclavicularjoint肩鎖韌39

胸鎖關(guān)節(jié)sternoclavicularjoint

鞍狀關(guān)節(jié)sellarjiont韌帶組織ligament

胸鎖前韌帶胸鎖后韌帶胸鎖上韌帶鎖間韌帶肋鎖韌帶關(guān)節(jié)盤articulardisc胸鎖關(guān)節(jié)sternoclavicularjoint

40肩胛下間隙subacromicalspace肱骨頭與喙肩韌帶之間humeralhead,Coracoacromiallig.肩峰acromion喙肩韌帶Coracoacromiallig.喙突coracoidprocess肩鎖關(guān)節(jié)acromioclavicularjoint內(nèi)容物：肩峰下滑囊subacromicalbursa肩袖rotatorcuff二頭肌長頭腱tendonoflongheadofbicepsbrachii肩胛下間隙subacromicalspace肱骨頭與喙肩韌41肩袖

rotatorcuff肩胛下?。簝?nèi)收、旋內(nèi)Subscapularis:adduction,medialrotation岡上?。和庹筍upraspinatus:abduction岡下?。盒釯nfraspinatus:externalrotation小圓?。盒釺eresminor:externalrotation肩袖rotatorcuff肩胛下?。簝?nèi)收、旋內(nèi)42ContentThisarticlewilldescribethebestclinicalshouldertestsasratedinthissystematicreviewandmeta-analysisoftheindividualtests.這篇文章描述了在綜述中被評估為最好的臨床上的肩關(guān)節(jié)的檢查方法。ContentThisarticlewilldescr43TestImpingementtests撞擊試驗(yàn)Rotatorcufftests肩袖試驗(yàn)SuperiorlabrumanteriortoposteriorlesionstestsSLAP損傷試驗(yàn)Instabilitytests不穩(wěn)定試驗(yàn)Acromioclaviculartests肩鎖關(guān)節(jié)試驗(yàn)TestImpingementtests撞擊試驗(yàn)44撞擊試驗(yàn)Neer征(篩查screen)Hawkins–Kennedy試驗(yàn)(篩查screen)空罐試驗(yàn)（確診confirm）撞擊試驗(yàn)Neer征(篩查screen)45撞擊試驗(yàn)

Neer征

陽性：肩部疼痛注射10ml的利多卡因來緩解疼痛

inject10mloflidocaine意義：肱骨大結(jié)節(jié)撞擊發(fā)生炎性的岡上肌以及肩峰下滑囊Thetuberculummajusimpingesthedegeneratedsupraspinatusandsubacromialbursaagainsttheacromion

撞擊試驗(yàn)

Neer征46Hawkins–Kennedy試驗(yàn)陽性：被動(dòng)內(nèi)旋導(dǎo)致疼痛

painwithforcedinternalrotation

意義：肱骨大結(jié)節(jié)促使岡上肌肌腱撞擊韌帶ThetuberculummajusforcesthesupraspinatustendonagainstthecoracoacromialeligamentHawkins–Kennedy試驗(yàn)47空罐試驗(yàn)Emptycantest

陽性：肩部疼痛意義：岡上肌的強(qiáng)度測試。肩胛下肌、岡下肌和小圓肌的電位相對不變。Strengthtestofthesupraspinatusmuscle.Thesubscapularis,infraspinatusandteresminorareelectricallycomparativelysilentinthisposition.空罐試驗(yàn)Emptycantest48Rotatorcufftests

肩袖試驗(yàn)外旋減弱征Externalrotationlagsign落臂征Droparmtest（假陽性）仰臥撞擊試驗(yàn)Supineimpingementtest腹部按壓試驗(yàn)BellypresstestRotatorcufftests

肩袖試驗(yàn)外旋減弱征E49Rotatorcufftests

肩袖試驗(yàn)

外旋減弱征

Externalrotationlagsign陽性：手臂掉落anangulardropoccur意義：手臂下落＞5°提示岡上肌腱或者岡下肌腱的局部撕脫Alagsignofmorethan5°isa(partial)tearoftheinfraspinatusorsupraspinatustendons.Rotatorcufftests

肩袖試驗(yàn)

外旋減弱征50落臂征Droparmtest陽性：患者身體可能會(huì)偏向受影響的一側(cè)，并且會(huì)突然縮短兩臂的伸展長度。

Thepatientmayleantotheaffectedsideandmaylowerthewholearmquitesuddenlyinabduction.意義：評定岡上肌和岡下肌的損傷

Thistestisdesignedforthe

assessment

ofsupraspinatusandinfraspinatusinjuries落臂征Droparmtest51仰臥撞擊試驗(yàn)

Supineimpingementtest陽性：疼痛的增加anincreasepain意義：評定肩袖損傷。疼痛可能是由于肩峰下間隙狹窄和加壓造成的。Assessanyrotatorcufftear.Painresultsfromnarrowingandcompressingthesubacromailspace.仰臥撞擊試驗(yàn)52腹部按壓試驗(yàn)

Bellypresstest陽性：患者不能保持肩關(guān)節(jié)最大限度的內(nèi)旋。肘關(guān)節(jié)向后移動(dòng)，肩內(nèi)旋消失。

Thepatientcan’tmaintainmaximalinternalrotation.Theelbowdropsbackwards,andinternalrotationislost意義：評定肩內(nèi)旋活動(dòng)度的減小Assessdecreasedinternalrotation.腹部按壓試驗(yàn)53

Superiorlabrumanteriortoposteriorlesionstests

SLAP損傷試驗(yàn)前方滑動(dòng)試驗(yàn)Anteriorslidetest（確診）肱二頭肌負(fù)重Ⅱ試驗(yàn)BicepsloadIItest（確診）

Superiorlabrumanteriorto54

前方滑動(dòng)試驗(yàn)Anteriorslidetest陽性：肩的疼痛或聲響

painoraclickinthefrontoftheshoulder意義：肱骨頭前后的運(yùn)動(dòng)會(huì)對上盂唇產(chǎn)生壓力。肱骨頭前方的運(yùn)動(dòng)也會(huì)導(dǎo)致肱二頭肌腱的牽伸，最終導(dǎo)致上唇復(fù)合體的伸展。Anteriorandsuperiorhumeralheadtranslationsallowstresstothesuperiorlabrum.Theupwardmotionalsocausestractiononthebicepstendon,stretchingthelabralcomplex.前方滑動(dòng)試驗(yàn)Anteriorslidetes55

肱二頭肌負(fù)重Ⅱ試驗(yàn)

BicepsloadIItest陽性：疼痛或加重的疼痛painormorepain意義：上盂唇從關(guān)節(jié)窩邊緣的剝落和疼痛的加重Thesuperiorlabrumispeeledoftheglenoidmarginandpainincreases.肱二頭肌負(fù)重Ⅱ試驗(yàn)BicepsloadIIte56不穩(wěn)定試驗(yàn)Instabilitytests恐懼試驗(yàn)Apprehensiontest再復(fù)位試驗(yàn)Relocationtest前方釋放試驗(yàn)Anteriorreleasetest不穩(wěn)定試驗(yàn)Instabilitytests恐懼試驗(yàn)App57恐懼試驗(yàn)

Apprehensiontest陽性：肩關(guān)節(jié)突然的恐懼感和疼痛Thereisasuddenapprehensionfeelingintheshoulderandpain.意義：組合的運(yùn)動(dòng)和向前的直接壓力會(huì)導(dǎo)致肩關(guān)節(jié)半脫位。Thecombinedmotionandanteriordirectedpressurecausessubluxationoftheshoulder.恐懼試驗(yàn)Apprehensiontest58

再復(fù)位試驗(yàn)Relocationtest陽性：疼痛的減輕，患者能夠忍受的最大的肩外旋位置Thereisareliefofpainandthepatientisabletotoleratemaximalexternalrotation.意義：向后的力把肱骨頭固定在適當(dāng)?shù)奈恢蒙蟃heposteriordirectedforcemaintainsthehumeralheadinposition.再復(fù)位試驗(yàn)Relocationtest59

前方釋放試驗(yàn)Anteriorreleasetest陽性：疼痛/疼痛加劇

Thereisasuddenpain/anincreaseinpain.意義：釋放后加的力量