冈上肌肌腱炎PPT医学课件.pptx

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,2018/8/29,#,肩关节,冈上肌,腱炎,钙化性冈上肌腱炎,（,Calcified Supraspinatus Tendonitis,）,1.CST is a kind of soft tissue lesions (belongs to,scapulohumeral periarthritis,),2.,Etiology,：,T,he repeated use of shoulder joint,、Subacromial impingement、Tendon degeneration、calcium deposition.,strian or,trauma,degeneration,calcium deposition,3.,Symptom,：,swell and pain,CST is more commonly seen in,women,tendinitis of supraspinatus muscle,and CST account for 21.5%in shoulder periarthriti.,1.,颗粒小,-,未刺激到肩峰下滑囊,无症状,2.,颗粒大,-,接触到肩峰下滑囊,-,外展痛,-,亚急性发作,3.,外伤或劳累,-,周围组织与滑囊炎症,-,急性发作,treatment,：puncture-aspiration,+,hormone therapy,or surgical treatment,imagemanifestations in early stage,X-RAY:,soft tissue mass in greatertuberosit,in homogeneousdensity,MRI:,low signalintensityonT1WI and high signal intensity,on T2WI(bone destruction),may be,misdiagnosedas,osteoblastoma,Imagemanifestations in late stage,X-Ray,:,Calcification,indifferentshapes,fluffy type:,rough/along the long axis supraspinatus,tendon,long strip:,edgestidy/along the long axis supraspinatus,tendon,sphere:,edgestidy/around the long axis supraspinatus,tendon,CST,the calcium deposit as hypointense signal,within the supraspinatus tendon(arrow),肩周炎（,Periarthrite Scapulohumerale,）,定义：,肩关节囊,及其周围,韧带,、,肌腱,和,滑囊,的慢性特异性炎症，又称“凝肩综合征”、“粘连性肩关节炎”、“五十肩”等,;,好发年龄及人群：,50,岁左右，,女性,多于男性；,文献报道：右侧发病高于左侧；,注意：肩周炎并非某一点的独立疾病，而是与肩关节周围病变（,如滑囊炎，肌腱炎、钙化、撕裂的等,）有密切联系，继而引起肩周软组织广泛粘连，肩关节活动障碍,;,病理,肩关节囊与滑膜隐窝的无菌炎症：充血、水肿、炎细胞浸润；,肩部周围肌肉、韧带、深筋膜的慢性劳损（可伴出血）；,Classification of Shoulder Portion Disorders,引起慢性肩痛与活动受限的肩周疾病,(Shoulder disorders with chronic shoulder pain and shoulder joint activity limits),1,.,肱二头肌长头肌腱鞘炎,(,myotenositis of long head of biceps brachii,),2.CST,；,3.,肩峰撞击综合征,:,肩峰下滑囊炎,/,肩袖撕裂,(Subacromial Impingement Syndrome:subacromial bursitis/rotator cuff tear),4.,盂唇,-,韧带复合体损伤,(,glenoidal labrum,-,Ligament,complex injury),5,.,冻结肩,(,粘连性关节囊炎,),：,Frozen Shoulder,(adhesive capsulitis ),肱二头肌长头肌肌腱炎,（,tendinitisof long headofbiceps brachiimuscle,）,1 degeneration and tear,Etiology：,impingement,entraped repeatedly-degeneration-tear,I,mage,M,anifestations,degeneration,：,thickening/increased signal on tendon,partial rotator cuff tear,:,Interruption,/thickening,、,high-signal on T2,full tear：,Interruption,/,feeling of empty,in intertubercular sulcus,2 dislocation and,subluxation,Etiology：,dysontogenesis,(medial wall of intertubercular sulcus),tendon lacerations of Subscapular Muscle Tendon,image manifestations,tendon displacement,(can be shifed in,subscapular muscle,),feeling of empty,in intertubercular sulcus,Normal and tendinitis of the long head of the biccps 21A:normal,21B:MR image shows the enlargement of the tendon(arrow)and abnormal internal high signal intensity,Partial tear of the long head of the biceps.,（,MR arthrographic images show the abnormal enter of the contrast material into the substance of the tendon(arrows),which represents a partial tear.,）,full tear,Dislocation of the long head of the biceps.Delamination-type tear of the subscapularis,肩关节撞击综合征,(I,mpingement,S,yndrome of the,S,houlder,),定义,(Definition),喙肩弓与肱骨头,之间的空间绝对或相对减小，使肩部在上举外展过程中，喙肩弓与肱骨头反复卡压其间的软组织结构,主要为,肩峰下滑囊,(Subacromial bursa),、冈上肌腱,(supraspinatus tendon),和部分冈下肌腱,(,lower-scapular,tendon),、肱二头肌长头腱,(long head of bicep tendon),引起症状，称为肩峰下撞击综合征。,Subdeltoidsubacromial bursitis,Subdeltoidsubacromial bursitis.,Acromial morphology,Tendinitis,Full thickness tear of the supraspinatus.,the supraspinatus tendon becomes thicker,with abnormal high signal as intense as fluid extending from the articular surface to the subacromial bursa surface(arrow).,Full thickness tear of the supraspinatus,retraction of the tendon,Full thickness tear of the subscapularis,partial thickness tear of the subscapularis,盂唇韧带复合体损伤（,the labral-ligamentous complex injury,）,:Inculding Bankart,lesiom and,Osseous Bankart lesion,major components,:glenoidal labrum/long head of bicep tendon/glenohumeral ligament,Classification,Throwers,SLAP injury,:11-1 O,commonly involved,the,long head of bicep tendon,Labrum injury/tendon lacerations,syndesmodiastasis(,glenoidal labrum,),Bankeart lesion,:1-6 O Periosteal tear,(85%-95%)shoulder dislocations,Reverse Bankert lesion,(6-11O,）,:posterior displacement of humeral head,labral tear,Classical Bankeart Lesion,盂唇韧带复合体损伤（,torn antteroinferior labrum,）,:Inculding Bankart,lesiom and,Osseous Bankart lesion,labral tear,(Periosteal tear),上方盂唇前后撕裂（,SLAP,）,completely separated from the superior glenoid and the biceps tendon,Synovial osteochondromatosis,intra-articular nodular calcifications.,The End,Thank you！,