小结
定义
病史和体格检查
关键诊断因素
- 肩关节僵硬
- 肩关节主动活动范围减少
- 肩关节被动活动范围减少
- 喙突疼痛试验阳性
- 耸肩试验阳性
其他诊断因素
- 存在的危险因素
- 肩部疼痛
- 诱发性试验无法排除的诊断
- 椎间孔挤压试验阴性（排除颈椎神经根病变）
- Hawkins 试验阴性（排除肩袖撞击）
- Neer 试验阴性（排除肩关节撞击）
- Speed 试验阴性（排除上盂唇前后部[superior labrum from anterior to posterior, SLAP]撕裂）
- O'Brien 试验阴性（排除上盂唇前后部[superior labrum from anterior to posterior, SLAP] 损伤）
- Yergason 试验阴性（排除肱二头肌腱近端病变）
- 恐惧试验阴性（排除肩关节前方不稳定）
- 复位试验阴性（进一步排除肩关节前方不稳定）
- Kim 试验阴性（排除肩关节后下方关节盂病变）
危险因素
- 年龄 40-70 岁
- 糖尿病
- 粘连性关节囊炎既往史
- 肩部疼痛及制动
- 肩关节手术史
- 女性
- 甲状腺疾病
诊断性检查
首要检查
- X 光平片
- 超声
需考虑的检查
- MRI/MR 肩关节造影
- CT 关节造影
治疗流程
所有患者
撰稿人
作者
Matthew T. Provencher, MD, CAPT MC USNR
Complex Shoulder Knee and Sports Surgery
The Steadman Clinic
Steadman Philippon Research Institute
Vail
CO
利益声明
MTP is a consultant for Arthrex and Joint Restoration Foundation. MTP receives royalties from Arthrex and has received an honorarium from Arthrosurface. He receives research funding from Vail Health and Steadman Philippon Research Institute.
Lance LeClere, MD, LCDR MC USN
Staff Surgeon
Team Physician
Orthopaedic Sports Medicine and Shoulder Surgery
Naval Health Clinic
US Naval Academy
Annapolis
MD
利益声明
LL declares that he has no competing interests.
Jennifer Smith, MD, LCDR MC USN
Staff Surgeon
Orthopaedic Sports Surgery
Naval Medical Center San Diego
San Diego
CA
利益声明
JS declares that she has no competing interests.
同行评议者
Matthew Busam, MD
Orthopedic Surgeon
Cincinnati Sports Medicine Research and Education Foundation
Cincinnati
OH
利益声明
MB declares that he has no competing interests.
Daniel Solomon, MD
Co-Director of Orthopedic Sports and Shoulder Service
Department of Orthopedic Surgery
Naval Medical Center San Diego
San Diego
CA
利益声明
DS declares that he has no competing interests.
Steven Corbett, BSc, PhD, FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Guy's and St Thomas’ Hospital NHS Foundation Trust
London
UK
利益声明
SC declares that he has no competing interests.
鉴别诊断
- 盂肱关节后脱位
- 肩袖损伤
- 肩峰下肩袖撞击
更多 鉴别诊断指南
- ACR 适宜性标准：慢性肩痛——无创伤性
- 循证医学临床指南-肩关节挛缩（冻肩）的诊断、评估及物理治疗：快速文献总结
更多 指南患者教育信息
肩袖损伤
更多 患者教育信息
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