肩袖损伤--英文版.pptx

Rotator Cuff Injury1.2.Rotator CuffLong Head of BicepsSubscapularisSupraspinatus,up facet of the humeral greater tuberosityInfraspinatus,middle facet of the humeral greater tuberosity Teres minor down facet of the humeral greater tuberosityInfraspinatus Humeral tuberosity3.4.MRIInfraspinatusTeres minorSupraspinatusInfraspinatus5.PathophysiologyIntrinsic FactorsVascular supply(?significance)Distal 1cm of supraspinatus tendon(early studies)Degenerative changesAge relatedChange in proteoglycan and collagen content in symptomatic tendons6.PathophysiologyExtrinsic factorsImpingementAcromial spursType III acromion and decreased geometric area of the supraspinatus outletCoracoacromial ligamentAC joint osteophytesCoracoid processGlenohumeral instabilityAccentuates abnormal loadingCan lead to internal impingementRepetitive useTensile overloadMuscle fatigueMicrotrauma7.MechanismTraumaticPitchingChronicPain and/or fatigue of cuffRotator Cuff dysfunctionImpingement with motion8.Diagnose1、HistoryPain on the lateral aspect of the shoulderStiffness,esp IRCannot lie on that sideWeakness,instability,crepitusPartial tears more sore and stifferAcute tear may have inciting event9.Diagnose2、Physical ExamImpingement testingNEER SIGNHawkins test10.Diagnose2、Physical ExamSUBSCAPLULARIS 肩胛下肌SUPRASPINATUS 冈上肌上肌 Jobes Test11.Diagnose2、Physical ExamINFRASPINATUS 冈下肌TERES MINOR 小圆肌Hornblowers sign:12.Diagnose3、ImagingPlain radiographsUltrasoundMRI13.14.small(1 cm),medium(13 cm),large(35 cm),or massive(5 cm）15.16.17.18.19.20.21.Treatment-surgery22.23.三角肌三角肌肱三头肌外侧头肱二头肌肱骨头24.斜方肌冈上肌锁骨肩峰端三角肌大圆肌肩胛下肌背阔肌肩胛骨肱骨头肱三头肌25.三角肌冈上肌肩峰斜方肌肱骨头肩胛骨肩胛下肌大圆肌肱三头肌长头背阔肌肱三头肌外侧头26.肩胛下肌27.28.