关节评价.ppt

Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Company Logo,Add Your Company Slogan,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third 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Master text styles,Second level,Third level,Fourth level,Fifth level,Company Logo,*,Click to edit Master title style,Company Logo,Add Your Company Slogan,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Company Logo,*,Click to edit Master text styles,Second level,Third level,Fourth 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Logo,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,LOGO,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,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,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,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,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,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,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,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,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,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,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,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,单击此处编辑母版标题样式,*,关节健康评价,Company Logo,Company Logo,肩关节的运动,运动形式,动作举例,参与运动的肌群,屈伸,前后摆臂,屈：,胸大肌骨部肌束、喙肱肌、三角肌前部肌束和肱二头肌,伸：,三角肌后部肌束、肱三头肌长头、背阔肌、冈下肌、小圆肌和大圆肌等。,外展内收,直立飞鸟,外展：,三角肌中部、冈上肌,内收：,胸大肌、背阔肌、大圆肌、冈下肌、小圆肌、肩胛下肌,内旋外旋,武术勾手亮掌,内旋：,胸大肌、三角肌前部、背阔肌、大圆肌,旋外：,三角肌后部、冈下肌、小圆肌,环转,武术抡臂,水平屈伸,扩胸运动,屈：,三角肌、冈上肌、胸大肌锁骨部、三角肌前束、喙肱肌、肱二头肌长头,伸：,三角肌、冈上肌、背阔肌、三角肌后部、冈下肌、小圆肌、大圆肌、肱三头肌长头,Company Logo,肩部运动损伤与检查方法,（一）杜格,(Dugas),征,（三）反弓试验,（二）痛弧试验,（四）肩关节内旋试验,患侧手掌置于健侧肩前（患肩呈内收内旋位），正常时肘内侧能触及胸壁。,若患侧肘内侧不能贴于胸壁都为阳性，提示患侧肩关节脱位。,肩关节外展上举时，正常者无疼痛。如果外展,60,度内不痛，,60120,度,。的弧度内出现疼痛，超过,120,度,。疼痛缓解或消失，上臂从上举位沿原路放下时，又在,12060,度,之间出现疼痛则为阳性，即出现“痛弧”，提示有肩袖损伤，尤其是冈上肌损伤的重要体征。,患侧上肢外上举再后伸呈反弓状，若出现肩部疼痛则为阳性，提示有肩袖损伤或肱二头肌长头肌腱腱鞘炎。,患者主动做肩极度内旋动作，即在屈肘位，前臂置于背后，若出现疼痛者为阳性，提示有肩袖损伤或肱二头肌腱腱鞘炎。,Company Logo,肩袖损伤,症状及体征,多数患者有一次和多次受伤史，部分患者由劳损所致。,疼痛，向上臂或颈部放射，夜间疼痛加重。肩关节活动受限，上臂外展或伴内、外旋转时疼痛加重。,压痛多在肩峰下和肱骨大结节处。,痛弧试验、反弓试验、肩关节内旋试验等均可出现阳性。,慢性损伤有反弓试验阳性及三角肌、冈上肌和冈下肌萎缩、乏力，晚期患者,X,线拍片，可有肱骨大结节骨质硬化、囊性变或肌腱硬化。,肩袖损伤是指肩袖肌腱或合并肩峰下滑囊的创伤性炎症病变。此伤在体操、投掷、排球、乒乓球、举重、游泳运动中较为多见。,病因及损伤机制,由于肩关节反复旋转或超常范围的运动，引起肩袖肌腱和肩峰下滑囊受到反复牵扯，并与肩峰和喙肩韧带不断的摩擦及挤压所致。,体操的转肩、投掷时的出手动作、举重时肩的突然背伸、排球的扣球、蝶泳时的划水动作等，都是引起此损伤的典型机制。,旋转,膝关节的运动,运动形式,动作举例,参与运动的肌群,屈伸,高抬腿跑,屈：,半腱肌、半膜肌、股二头肌、股薄肌、缝匠肌和腓肠肌,。,伸：,股四头肌。,旋内,足外脚背踢球,大腿后面内侧的半腱肌、半膜肌、缝匠肌、骨股肌及小腿后面内侧的腓肠肌内侧头,旋外,足内脚背踢球,大腿后外侧的肱二头肌和小腿外侧的腓肠肌外侧头,Company Logo,膝部运动损伤的检查方法,（一）膝关节侧搬分离试验,患者仰卧,膝关节微屈,(25,30,),，检查者一手握住并固定患者小腿下端，另一手放在患膝外侧，被动使膝关节外翻，,若膝内侧疼痛则为内侧韧带扭伤；,如内侧关节间隙有开口感，膝外翻活动异常为阳性，提示膝内侧韧带断裂。,也可用同样的原理使膝内翻来检查膝外侧副韧带断裂。,Company Logo,（二）抽屉试验,屈膝,90度固定足,对胫骨上端用力牵拉和后推，双侧对比,异常向前移动前十字交叉韧带断裂,异常向后移动后十字交叉韧带断裂,Company Logo,（三）麦(Me murray)氏试验,仰卧，,屈膝屈髋，,检查者一手握住患足部，另一手扶在膝上，,小腿外展外旋，缓缓伸直膝关节，若内侧关节间隙痛或有响声，则内侧半月板损伤,相同道理，小腿内收内旋可检查外侧半月板,Company Logo,（四）艾(Appley)氏研磨试验,俯卧，伸髋、屈膝,90度,向下挤压，旋内/外膝内痛半月板损伤,向上牵拉，旋内/外疼痛韧带损伤,Company Logo,（五）髌骨软骨磨擦试验,用手掌按压患者髌骨，嘱患者屈伸膝关节或上下、左右错动髌骨，若有疼痛或粗糙的磨擦音、磨擦感为阳性，提示髌骨软骨病。,（六）单足半蹲试验,嘱患者单足支撑，逐渐下蹲，出现膝痛膝软为阳性。提示髌骨周围腱止装置损伤或髌骨软骨病。,Company Logo,踝及足部运动损伤的检查方法,(一)强迫内翻试验,检查者一手握住患肢小腿下部并固定，另一手握患足外侧将踝关节内翻，若外侧疼痛，踝关节无异常活动，提示踝关节外侧韧带扭伤。若两侧对比，距上关节外侧“开口”增大，出现异常的内翻活动，则提示距腓前韧带或与跟腓韧带同时断裂。,Company Logo,踝及足部运动损伤的检查方法,(二)强迫外翻试验,检查者一手握住患肢小腿下部并固定，另一手握住患足内侧将踝关节外翻，若出现踝关节内侧疼痛，无关节不稳，提示内侧三角韧带扭伤；若伴有关节不稳，出现异常外翻活动，提示三角韧带断裂。,Company Logo,踝及足部运动损伤的检查方法,(三）踝关节抽屉试验,检查者一手握患肢小腿下部，另一手握足跟，使距骨向前或向后错动。两踝对比，若患侧括动范围较大为阳性，提示踝关节外侧韧带或内侧韧带全断裂。,Company Logo,(四)捏住拇趾足外翻抗阻力试验,检查者捏住患肢拇趾，嘱患者踝关节跖屈做足的外翻，若第五跖骨基底部疼痛则为阳性，提示第五跖骨基管骨折。,(五)捏小腿三头肌试验,患者俯卧，两足置床沿外。检查者用手捏患肢小腿三头肌肌腹，正常者捏肌肉时踝关节立即跖屈，若踝关节无跖屈活动则为阳性，提示跟腱完全断裂。,踝及足部运动损伤的检查方法,