肩关节的临床检查方法课件

肩关节的临床检查方法

Clinicaltestsinshoulderexamination:howto

performthem肩关节的临床检查方法

Clinicaltestsins1

Background

Theshoulderisoftenconsideredadifficultjointtoexamine,andthisispartlyduetothelargenumberofdifferentclinicaltestsofshoulderfunction.肩关节通常被认为是一种很难检查的关节，在一定程度上是因为临床上肩关节功能的检查方法较多。Thecommonestshoulderinjuriesinclude:impingement,rotatorcuffinjuries,labraltears,instabilityandacromioclaviculardysfunction.常见的肩关节损伤包括：肩峰撞击综合征、肩袖的损伤、盂唇的损伤、肩关节的不稳定性以及肩锁关节的功能障碍。Background

Theshoulderiso2

Theshoulder盂肱关节

glenohumeraljoint肩锁关节

acromioclavicularjoint胸锁关节sternoclavicularjoint

肩肱关节（肩胛下间隙）

subacromiclspace肩胛胸廓关节Scapularthoracicjoint也有将喙锁间联系称为喙锁关节CoracoclavicularjointTheshoulder盂肱关节glenohumer3盂肱关节glenohumeraljoint肱骨头humeralhead盂窝glenoidcavity盂唇glenoidlabrum关节囊articularcapsule韧带ligament支持结构supportingstructure盂肱关节glenohumeraljoint肱骨头hume4盂肱关节glenohumeraljoint关节盂关节囊articularcapsulethinandlax,luxateinthefront

andbottom盂肱关节glenohumeraljoint关节盂关节囊a5肩锁关节acromioclavicularjoint肩锁韧带Acromioclavicularlig.喙锁韧带Coracoclavicularlig.斜方韧带Trapezoidlig.锥状韧带Conoidlig.肩锁关节acromioclavicularjoint肩锁韧6

胸锁关节sternoclavicularjoint

鞍状关节sellarjiont韧带组织ligament

胸锁前韧带胸锁后韧带胸锁上韧带锁间韧带肋锁韧带关节盘articulardisc胸锁关节sternoclavicularjoint

7肩胛下间隙subacromicalspace肱骨头与喙肩韧带之间humeralhead,Coracoacromiallig.肩峰acromion喙肩韧带Coracoacromiallig.喙突coracoidprocess肩锁关节acromioclavicularjoint内容物：肩峰下滑囊subacromicalbursa肩袖rotatorcuff二头肌长头腱tendonoflongheadofbicepsbrachii肩胛下间隙subacromicalspace肱骨头与喙肩韧8肩袖

rotatorcuff肩胛下肌：内收、旋内Subscapularis:adduction,medialrotation冈上肌：外展Supraspinatus:abduction冈下肌：旋外Infraspinatus:externalrotation小圆肌：旋外Teresminor:externalrotation肩袖rotatorcuff肩胛下肌：内收、旋内9ContentThisarticlewilldescribethebestclinicalshouldertestsasratedinthissystematicreviewandmeta-analysisoftheindividualtests.这篇文章描述了在综述中被评估为最好的临床上的肩关节的检查方法。ContentThisarticlewilldescr10TestImpingementtests撞击试验Rotatorcufftests肩袖试验SuperiorlabrumanteriortoposteriorlesionstestsSLAP损伤试验Instabilitytests不稳定试验Acromioclaviculartests肩锁关节试验TestImpingementtests撞击试验11撞击试验Neer征(筛查screen)Hawkins–Kennedy试验(筛查screen)空罐试验（确诊confirm）撞击试验Neer征(筛查screen)12撞击试验

Neer征

阳性：肩部疼痛注射10ml的利多卡因来缓解疼痛

inject10mloflidocaine意义：肱骨大结节撞击发生炎性的冈上肌以及肩峰下滑囊Thetuberculummajusimpingesthedegeneratedsupraspinatusandsubacromialbursaagainsttheacromion

撞击试验

Neer征13Hawkins–Kennedy试验阳性：被动内旋导致疼痛

painwithforcedinternalrotation

意义：肱骨大结节促使冈上肌肌腱撞击韧带ThetuberculummajusforcesthesupraspinatustendonagainstthecoracoacromialeligamentHawkins–Kennedy试验14空罐试验Emptycantest

阳性：肩部疼痛意义：冈上肌的强度测试。肩胛下肌、冈下肌和小圆肌的电位相对不变。Strengthtestofthesupraspinatusmuscle.Thesubscapularis,infraspinatusandteresminorareelectricallycomparativelysilentinthisposition.空罐试验Emptycantest15Rotatorcufftests

肩袖试验外旋减弱征Externalrotationlagsign落臂征Droparmtest（假阳性）仰卧撞击试验Supineimpingementtest腹部按压试验BellypresstestRotatorcufftests

肩袖试验外旋减弱征E16Rotatorcufftests

肩袖试验

外旋减弱征

Externalrotationlagsign阳性：手臂掉落anangulardropoccur意义：手臂下落＞5°提示冈上肌腱或者冈下肌腱的局部撕脱Alagsignofmorethan5°isa(partial)tearoftheinfraspinatusorsupraspinatustendons.Rotatorcufftests

肩袖试验

外旋减弱征17落臂征Droparmtest阳性：患者身体可能会偏向受影响的一侧，并且会突然缩短两臂的伸展长度。

Thepatientmayleantotheaffectedsideandmaylowerthewholearmquitesuddenlyinabduction.意义：评定冈上肌和冈下肌的损伤

Thistestisdesignedforthe

assessment

ofsupraspinatusandinfraspinatusinjuries落臂征Droparmtest18仰卧撞击试验

Supineimpingementtest阳性：疼痛的增加anincreasepain意义：评定肩袖损伤。疼痛可能是由于肩峰下间隙狭窄和加压造成的。Assessanyrotatorcufftear.Painresultsfromnarrowingandcompressingthesubacromailspace.仰卧撞击试验19腹部按压试验

Bellypresstest阳性：患者不能保持肩关节最大限度的内旋。肘关节向后移动，肩内旋消失。

Thepatientcan’tmaintainmaximalinternalrotation.Theelbowdropsbackwards,andinternalrotationislost意义：评定肩内旋活动度的减小Assessdecreasedinternalrotation.腹部按压试验20

Superiorlabrumanteriortoposteriorlesionstests

SLAP损伤试验前方滑动试验Anteriorslidetest（确诊）肱二头肌负重Ⅱ试验BicepsloadIItest（确诊）

Superiorlabrumanteriorto21

前方滑动试验Anteriorslidetest阳性：肩的疼痛或声响

painoraclickinthefrontoftheshoulder意义：肱骨头前后的运动会对上盂唇产生压力。肱骨头前方的运动也会导致肱二头肌腱的牵伸，最终导致上唇复合体的伸展。Anteriorandsuperiorhumeralheadtranslationsallowstresstothesuperiorlabrum.Theupwardmotionalsocausestractiononthebicepstendon,stretchingthelabralcomplex.前方滑动试验Anteriorslidetes22

肱二头肌负重Ⅱ试验

BicepsloadIItest阳性：疼痛或加重的疼痛painormorepain意义：上盂唇从关节窝边缘的剥落和疼痛的加重Thesuperiorlabrumispeeledoftheglenoidmarginandpainincreases.肱二头肌负重Ⅱ试验BicepsloadIIte23不稳定试验Instabilitytests恐惧试验Apprehensiontest再复位试验Relocationtest前方释放试验Anteriorreleasetest不稳定试验Instabilitytests恐惧试验App24恐惧试验

Apprehensiontest阳性：肩关节突然的恐惧感和疼痛Thereisasuddenapprehensionfeelingintheshoulderandpain.意义：组合的运动和向前的直接压力会导致肩关节半脱位。Thecombinedmotionandanteriordirectedpressurecausessubluxationoftheshoulder.恐惧试验Apprehensiontest25

再复位试验Relocationtest阳性：疼痛的减轻，患者能够忍受的最大的肩外旋位置Thereisareliefofpainandthepatientisabletotoleratemaximalexternalrotation.意义：向后的力把肱骨头固定在适当的位置上Theposteriordirectedforcemaintainsthehumeralheadinposition.再复位试验Relocationtest26

前方释放试验Anteriorreleasetest阳性：疼痛/疼痛加剧

Thereisasuddenpain/anincreaseinpain.意义：释放后加的力量后，肱骨头向前方半脱位

Releasingtheposteriorlydirectedforce,thehumeralheadcansubluxateanteriorly.前方释放试验Anteriorreleasetest27Acromioclaviculartests

肩锁关节试验O’Brien试验（确诊）肩锁关节压痛试验ACjointtendernesstest（筛查）Acromioclaviculartests

肩锁关节试验28O’Brien试验阳性：肩锁关节周围的疼痛更多的表现在抵抗内旋上Thereisapainaroundtheacromioclavicular(AC)joint,morepresentwithresistedinternalrotation意义：肱骨大结节挤推肩峰使肩锁关节受压Theacromionispushedbythetuberculummajus,compressingtheACjointO’Brien试验29

肩锁关节压痛试验ACjointtendernesstest阳性：疼痛肩锁关节压痛试验30Mygains学习并掌握了多种有效的临床肩关节检查方法；Welearnandmastermanyeffectiveclinicalshoulderjointinspectionmethods2.在今后的学习中，要侧重对于学习的概括；Inthefuture,wewillfocusonlearninggeneralization;3.临床检查中要重视个体化检查以得到正确有效的结果。Weshouldpayattentiontotheindividualchecktogetcorrectresultsintheclinicalexamination.Mygains学习并掌握了多种有效的临床肩关节检查方法；31Advantages文章结构清晰，图文并茂，一目了然；

Thisarticlehasclearstructureandphotographsoftheexacttestprocedure;2.文章研究方向明确，对怎样执行肩关节临床检查做了一个实用性概括，很有目的性和针对性；

Thisarticlehasaclearstudyingdirectiononhowtocarryouttheclinicalshoulderjointexaminationanddoapracticalsummary,thisisobjectiveandtargeted;3.为未来检验肩关节测试的可靠性与有效性引导了方向。Thisarticleguidesthedirectionofinspectingthereliabilityandvalidityofshouldertest.Advantages文章结构清晰，图文并茂，一目了然；32THANKYOU!THANKYOU!33肩关节的临床检查方法

Clinicaltestsinshoulderexamination:howto

performthem肩关节的临床检查方法

Clinicaltestsins34

Background

Theshoulderisoftenconsideredadifficultjointtoexamine,andthisispartlyduetothelargenumberofdifferentclinicaltestsofshoulderfunction.肩关节通常被认为是一种很难检查的关节，在一定程度上是因为临床上肩关节功能的检查方法较多。Thecommonestshoulderinjuriesinclude:impingement,rotatorcuffinjuries,labraltears,instabilityandacromioclaviculardysfunction.常见的肩关节损伤包括：肩峰撞击综合征、肩袖的损伤、盂唇的损伤、肩关节的不稳定性以及肩锁关节的功能障碍。Background

Theshoulderiso35

Theshoulder盂肱关节

glenohumeraljoint肩锁关节

acromioclavicularjoint胸锁关节sternoclavicularjoint

肩肱关节（肩胛下间隙）

subacromiclspace肩胛胸廓关节Scapularthoracicjoint也有将喙锁间联系称为喙锁关节CoracoclavicularjointTheshoulder盂肱关节glenohumer36盂肱关节glenohumeraljoint肱骨头humeralhead盂窝glenoidcavity盂唇glenoidlabrum关节囊articularcapsule韧带ligament支持结构supportingstructure盂肱关节glenohumeraljoint肱骨头hume37盂肱关节glenohumeraljoint关节盂关节囊articularcapsulethinandlax,luxateinthefront

andbottom盂肱关节glenohumeraljoint关节盂关节囊a38肩锁关节acromioclavicularjoint肩锁韧带Acromioclavicularlig.喙锁韧带Coracoclavicularlig.斜方韧带Trapezoidlig.锥状韧带Conoidlig.肩锁关节acromioclavicularjoint肩锁韧39

胸锁关节sternoclavicularjoint

鞍状关节sellarjiont韧带组织ligament

胸锁前韧带胸锁后韧带胸锁上韧带锁间韧带肋锁韧带关节盘articulardisc胸锁关节sternoclavicularjoint

40肩胛下间隙subacromicalspace肱骨头与喙肩韧带之间humeralhead,Coracoacromiallig.肩峰acromion喙肩韧带Coracoacromiallig.喙突coracoidprocess肩锁关节acromioclavicularjoint内容物：肩峰下滑囊subacromicalbursa肩袖rotatorcuff二头肌长头腱tendonoflongheadofbicepsbrachii肩胛下间隙subacromicalspace肱骨头与喙肩韧41肩袖

rotatorcuff肩胛下肌：内收、旋内Subscapularis:adduction,medialrotation冈上肌：外展Supraspinatus:abduction冈下肌：旋外Infraspinatus:externalrotation小圆肌：旋外Teresminor:externalrotation肩袖rotatorcuff肩胛下肌：内收、旋内42ContentThisarticlewilldescribethebestclinicalshouldertestsasratedinthissystematicreviewandmeta-analysisoftheindividualtests.这篇文章描述了在综述中被评估为最好的临床上的肩关节的检查方法。ContentThisarticlewilldescr43TestImpingementtests撞击试验Rotatorcufftests肩袖试验SuperiorlabrumanteriortoposteriorlesionstestsSLAP损伤试验Instabilitytests不稳定试验Acromioclaviculartests肩锁关节试验TestImpingementtests撞击试验44撞击试验Neer征(筛查screen)Hawkins–Kennedy试验(筛查screen)空罐试验（确诊confirm）撞击试验Neer征(筛查screen)45撞击试验

Neer征

阳性：肩部疼痛注射10ml的利多卡因来缓解疼痛

inject10mloflidocaine意义：肱骨大结节撞击发生炎性的冈上肌以及肩峰下滑囊Thetuberculummajusimpingesthedegeneratedsupraspinatusandsubacromialbursaagainsttheacromion

撞击试验

Neer征46Hawkins–Kennedy试验阳性：被动内旋导致疼痛

painwithforcedinternalrotation

意义：肱骨大结节促使冈上肌肌腱撞击韧带ThetuberculummajusforcesthesupraspinatustendonagainstthecoracoacromialeligamentHawkins–Kennedy试验47空罐试验Emptycantest

阳性：肩部疼痛意义：冈上肌的强度测试。肩胛下肌、冈下肌和小圆肌的电位相对不变。Strengthtestofthesupraspinatusmuscle.Thesubscapularis,infraspinatusandteresminorareelectricallycomparativelysilentinthisposition.空罐试验Emptycantest48Rotatorcufftests

肩袖试验外旋减弱征Externalrotationlagsign落臂征Droparmtest（假阳性）仰卧撞击试验Supineimpingementtest腹部按压试验BellypresstestRotatorcufftests

肩袖试验外旋减弱征E49Rotatorcufftests

肩袖试验

外旋减弱征

Externalrotationlagsign阳性：手臂掉落anangulardropoccur意义：手臂下落＞5°提示冈上肌腱或者冈下肌腱的局部撕脱Alagsignofmorethan5°isa(partial)tearoftheinfraspinatusorsupraspinatustendons.Rotatorcufftests

肩袖试验

外旋减弱征50落臂征Droparmtest阳性：患者身体可能会偏向受影响的一侧，并且会突然缩短两臂的伸展长度。

Thepatientmayleantotheaffectedsideandmaylowerthewholearmquitesuddenlyinabduction.意义：评定冈上肌和冈下肌的损伤

Thistestisdesignedforthe

assessment

ofsupraspinatusandinfraspinatusinjuries落臂征Droparmtest51仰卧撞击试验

Supineimpingementtest阳性：疼痛的增加anincreasepain意义：评定肩袖损伤。疼痛可能是由于肩峰下间隙狭窄和加压造成的。Assessanyrotatorcufftear.Painresultsfromnarrowingandcompressingthesubacromailspace.仰卧撞击试验52腹部按压试验

Bellypresstest阳性：患者不能保持肩关节最大限度的内旋。肘关节向后移动，肩内旋消失。

Thepatientcan’tmaintainmaximalinternalrotation.Theelbowdropsbackwards,andinternalrotationislost意义：评定肩内旋活动度的减小Assessdecreasedinternalrotation.腹部按压试验53

Superiorlabrumanteriortoposteriorlesionstests

SLAP损伤试验前方滑动试验Anteriorslidetest（确诊）肱二头肌负重Ⅱ试验BicepsloadIItest（确诊）

Superiorlabrumanteriorto54

前方滑动试验Anteriorslidetest阳性：肩的疼痛或声响

painoraclickinthefrontoftheshoulder意义：肱骨头前后的运动会对上盂唇产生压力。肱骨头前方的运动也会导致肱二头肌腱的牵伸，最终导致上唇复合体的伸展。Anteriorandsuperiorhumeralheadtranslationsallowstresstothesuperiorlabrum.Theupwardmotionalsocausestractiononthebicepstendon,stretchingthelabralcomplex.前方滑动试验Anteriorslidetes55

肱二头肌负重Ⅱ试验

BicepsloadIItest阳性：疼痛或加重的疼痛painormorepain意义：上盂唇从关节窝边缘的剥落和疼痛的加重Thesuperiorlabrumispeeledoftheglenoidmarginandpainincreases.肱二头肌负重Ⅱ试验BicepsloadIIte56不稳定试验Instabilitytests恐惧试验Apprehensiontest再复位试验Relocationtest前方释放试验Anteriorreleasetest不稳定试验Instabilitytests恐惧试验App57恐惧试验

Apprehensiontest阳性：肩关节突然的恐惧感和疼痛Thereisasuddenapprehensionfeelingintheshoulderandpain.意义：组合的运动和向前的直接压力会导致肩关节半脱位。Thecombinedmotionandanteriordirectedpressurecausessubluxationoftheshoulder.恐惧试验Apprehensiontest58

再复位试验Relocationtest阳性：疼痛的减轻，患者能够忍受的最大的肩外旋位置Thereisareliefofpainandthepatientisabletotoleratemaximalexternalrotation.意义：向后的力把肱骨头固定在适当的位置上Theposteriordirectedforcemaintainsthehumeralheadinposition.再复位试验Relocationtest59

前方释放试验Anteriorreleasetest阳性：疼痛/疼痛加剧

Thereisasuddenpain/anincreaseinpain.意义：释放后加的力量