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肩周炎的康复治疗肩周炎的康复治疗四川大学华西医院康复医学科四川大学华西医院康复医学科高强高强一、肩部解剖一、肩部解剖�I.I.I.I.肩部的骨骼A.肩胛骨Scapular1.肩胛岗ScapularSpine齐对第三胸椎B.锁骨ClavicleC.肱骨Humerous肩部的骨骼肩部的骨骼BONESOFTHESHOULDERBONESOFTHESHOULDERBONESOFTHESHOULDERBONESOFTHESHOULDERBONESOFTHESHOULDERBONESOFTHESHOULDERBONESOFTHESHOULDERBONESOFTHESHOULDER�II.II.II.II.关节ArticulationsArticulationsArticulationsArticulationsA.盂肱关节Glenohumeraljoint(GHJoint)1.关节盂与肱骨头关节2.(如)高尔夫球放在球座上a.与骨的关节接触30%b.与关节盂的接触75%B.肩胛-胸壁关节ScapulothoracicarticulationC.肩锁关节AcromioclavicularJoint(ACJoint)1.肩峰与锁骨D.胸锁关节SternoclavicularJoint(SCJoint)肩部的关节肩部的关节JOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDER肩部的关节肩部的关节JOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDERJOINTSOFTHESHOULDER肩部的韧带肩部的韧带LIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDERLIGAMENTSOFTHESHOULDER肩部滑液囊肩部滑液囊BURSAEOFTHESHOULDERBURSAEOFTHESHOULDERBURSAEOFTHESHOULDERBURSAEOFTHESHOULDERBURSAEOFTHESHOULDERBURSAEOFTHESHOULDERBURSAEOFTHESHOULDERBURSAEOFTHESHOULDER�III.III.III.III.肩胛-中轴骨的肌肉MusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaA.斜方肌TrapeziusB.肩胛提肌LevatorscapulaeC.菱形肌RhomboidsD.前锯肌SerratusanteriorE.胸小肌Pectoralisminor肩胛-中轴骨的肌肉肩胛-中轴骨的肌肉MusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapula肩胛-中轴骨的肌肉肩胛-中轴骨的肌肉MusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapula肩胛-中轴骨的肌肉肩胛-中轴骨的肌肉MusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapula胸小肌PectoralisMinorMs.肩胛-中轴骨的肌肉肩胛-中轴骨的肌肉MusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapulaMusclesattachingAxialskeletontoScapula前锯肌SerratusAnteriorMs.�IV.IV.IV.IV.中轴骨-肱骨间的肌肉MusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoHumerusHumerusHumerusHumerusA.背阔肌LatissimusdorsiB.胸大肌Pectoralismajor中轴骨-肱骨间的肌肉中轴骨-肱骨间的肌肉MusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoHumerusHumerusHumerusHumerusHumerusHumerusHumerusHumerus中轴骨-肱骨间的肌肉中轴骨-肱骨间的肌肉MusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoMusclesattachingAxialskeletontoHumerusHumerusHumerusHumerusHumerusHumerusHumerusHumerus胸大肌PectoralisMajorMs.�V.V.V.V.肩关节回旋肌群(肩袖)MusclesoftheRotatorCuffMusclesoftheRotatorCuffMusclesoftheRotatorCuffMusclesoftheRotatorCuffA.肩胛下肌SubscapularisB.岗上肌SupraspinatusC.岗下肌InfraspinatusD.小圆肌TeresMinor�VI.VI.VI.VI.肩峰下间隙SubacromialSubacromialSubacromialSubacromialSpaceSpaceSpaceSpaceA.A.A.A.回旋肌群(肩袖)1.1.1.1.前方的回旋肌群AnteriorRotatorCuffa.a.a.a.肩胛下肌SubscapularisMuscle2.2.2.2.后方回旋肌群PosteriorRotatorCuffa.a.a.a.岗下肌InfraspinatusMuscleb.b.b.b.小圆肌TeresMinorMuscle3.3.3.3.上方回旋肌SuperiorRotatorCuffa.a.a.a.岗上肌SupraspinatusMuscleB.肩峰下滑囊Subacromialbursae1.将肌肉与上方的喙突-肩峰弓分开2.包括三角肌下滑囊和喙突下滑囊肩峰下间隙肩峰下间隙SubacromialSubacromialSpaceSpaceVII.VII.VII.VII.VII.VII.VII.VII.臂丛神经臂丛神经BRACHIALPLEXUSBRACHIALPLEXUSBRACHIALPLEXUSBRACHIALPLEXUSBRACHIALPLEXUSBRACHIALPLEXUSBRACHIALPLEXUSBRACHIALPLEXUS二、肩周炎康复概述二、肩周炎康复概述(一)定义:�肩周炎是以肩关节疼痛,关节挛缩和功能受限为主要表现的疾病。�广义的肩关节周围炎是肩痛症笼统诊断,按不同的发病部位,病因和病理特点,可以分为4大类:肩周围滑液囊病变;盂肱关节腔病变;肌腱及腱鞘的退化改变;其它肩周围的退化病变�狭义肩关节周围炎多指冻结肩,又称疼痛性肩关节挛缩症,本病50岁前后是高发年龄,又称“五十肩”。(二)特点(二)特点�本病的特点是突发性发病,表现为肩痛,活动受限。其病程可历经数月乃至数年,炎症逐渐消退,症状渐渐缓解,是具有自愈倾向的自限性疾病。(三)病因病理(三)病因病理�病因病理:本病的确切病因尚不清楚,有人认为与自身免疫有关,也有人认为与内分泌失调有关,在颈椎病、糖尿病及偏瘫患者中本病发病率较高。�病理学表现为多滑囊病变,以及盂肱关节滑膜腔、肌腱、韧带病变。早期滑膜水肿、充血、绒毛肥大伴有渗出,后期纤维素样物质沉积,滑膜腔粘连闭锁。(四)临床分期(四)临床分期本病发病过程分成三期:�(一)急性期:又称冻结进行期,起病急骤,疼痛剧烈,肌肉痉挛、关节活动受限,夜间疼痛加重,难以入眠。肩部压痛范围广泛。急性期可持续2-4周,X线检查一般无异常发现。�(二)慢性期:又称冻结期。此时疼痛症状相对较轻,但压痛范围
本文标题:肩周炎的康复治疗
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