本文選題：肩部 + 壓痛點��； 參考：《南方醫(yī)科大學(xué)》2008年碩士論文

【摘要】： 目的: 一、明確肩部軟組織損傷性疾病常見壓痛點的分布規(guī)律及臨床特征,為肩痛患者的診治提供更為詳實的臨床資料。 二、為肩部常見疾病的體表定位、手法操作和扳機點注射等治療提供解剖形態(tài)學(xué)資料及應(yīng)用基礎(chǔ)。 方法: 一、臨床研究:選取54例主訴肩部疼痛的患者,明確診斷,分別依次行局部壓痛點檢查及解剖定位并進(jìn)行局部壓痛的疼痛量化評分(visual analogue scale,VAS)。所得計量資料用均數(shù)±標(biāo)準(zhǔn)差((?)±s)表示,用SPSS13.0統(tǒng)計軟件對數(shù)據(jù)行方差分析。明確其疼痛的部位、性質(zhì)、持續(xù)時間、牽涉痛的范圍和伴隨癥狀以及以往診治情況等。 二、解剖學(xué)研究:選取6具成人防腐尸體,觀測肩部,尤其是常見痛點的解剖形態(tài)學(xué)結(jié)構(gòu)特征,毗鄰關(guān)系以及血管、神經(jīng)等走行及分布特征。同時注意觀察肩部常見穴位與痛點的解剖學(xué)關(guān)系。 結(jié)果: 一、臨床研究:肩部疼痛的患者較為多見。由于病因不同患者的癥狀也各有特點。但多以疼痛、運動受限和局限性壓痛為主要癥狀,有時可表現(xiàn)疼痛逐漸增加,夜間痛較著,尤以肩外展外旋時疼痛加重,亦可向肩胛部、頸、手等處放射。壓痛點多在上斜方肌、岡下肌、喙突、小結(jié)節(jié)和肩峰下等處,常可隨肱骨的旋轉(zhuǎn)而移位,可導(dǎo)致肩部滑囊壁的增厚和粘連,肩關(guān)節(jié)活動范圍逐漸縮小。176例患者中,診斷為岡下肌筋膜炎52例,上斜方肌筋膜炎50例、凍結(jié)肩24例、肩袖損傷12例、肩胛提肌損傷10例、喙突炎6例、肩峰下滑囊炎5例、肩鎖關(guān)節(jié)損傷4例、后斜角肌筋膜炎2例、岡上肌筋膜炎各1例。 二、解剖學(xué)研究:喙突外側(cè)端為肱二頭肌短頭及喙肱肌附著,中部前側(cè)半為胸小肌肌腱附著,后側(cè)半為喙肩韌帶附著,內(nèi)側(cè)部為喙鎖韌帶,在胸小肌肌腱及喙鎖韌帶之間尚有鎖骨下肌的腱膜附著。結(jié)節(jié)間溝寬度右側(cè)低于左側(cè),深度右側(cè)高于左側(cè)。右側(cè)小結(jié)節(jié)向上突起,增生明顯,而左側(cè)小結(jié)節(jié)則多低平,結(jié)節(jié)間溝較右側(cè)淺。岡下肌覆蓋于肩胛骨岡下窩內(nèi),為三角形扁肌,肌纖維呈多羽狀。該肌的上外側(cè)部被三角肌后上部肌纖維所掩蓋。 結(jié)論: 一、臨床上,肌筋膜炎是肩部最常見的軟組織損傷性疾病,其所致的壓痛點也是發(fā)生率最高,壓痛最明顯的部位。這些肌筋膜炎所致的肩部壓痛點僅局限于該病變肌肉,且壓痛多為1處,臨床上多根據(jù)壓痛點即可做出大致的診斷。凍結(jié)肩和肩袖損傷的壓痛點較肩部其他軟組織損傷性疾病的壓痛點多,且廣泛,二者壓痛點的分布雖多有重疊,但也有不同。同一疾病的不同階段,其壓痛程度也有所不同。 二、肩部不同軟組織損傷性疾病具有各自的壓痛點分布部位和特征。喙突部出現(xiàn)壓痛多見于凍結(jié)肩和喙突炎。肩袖損傷的壓痛點較多,多見于肩胛區(qū)以及喙突與小結(jié)節(jié)之間等處。少見于上斜方肌、喙突和結(jié)節(jié)間溝等處,這是與凍結(jié)肩相區(qū)分之處。 三、肩關(guān)節(jié)的結(jié)構(gòu)比較復(fù)雜,包括肩關(guān)節(jié)及其周圍的肌肉、肌腱、韌帶、滑囊和關(guān)節(jié)囊等結(jié)構(gòu),在對痛點進(jìn)行封閉等治療時,應(yīng)熟悉局部解剖關(guān)系,對于毗鄰血管、神經(jīng)部位注射時需加以小心。
[Abstract]:Objective:
First, to clarify the distribution and clinical characteristics of common tenderness points of shoulder soft tissue injuries, and provide more detailed clinical data for the diagnosis and treatment of shoulder pain patients.
Two, provide anatomical and morphological data and applied basis for the treatment of shoulder diseases such as body surface positioning, manipulation and trigger point injection.
Method:
First, clinical study: 54 patients who complained of shoulder pain were selected to make a definite diagnosis, and the local pressure point examination and anatomic location were performed in turn and the pain quantification score of local pressure pain (visual analogue scale, VAS). The measured data were expressed with mean standard deviation ((?) + s), and the variance analysis of data lines was made by SPSS13.0 software. The location, nature, duration of pain, the range of pain involved and accompanying symptoms, as well as previous diagnosis and treatment, were analyzed.
Two, anatomical study: 6 adult cadavers were selected to observe the anatomical structure features of the shoulder, especially the common pain points, the adjacent relationship and the characteristics of the blood vessels and nerves, and the anatomical relationship between the common acupoints and the pain points.
Result:
One, clinical study: the patients with shoulder pain are more common. The symptoms of the patients with different causes are also characterized. But the main symptoms are pain, limited movement and limited pressure pain. Sometimes the pain increases gradually, the pain is more at night, especially when the abduction of the abductor is aggravated, and it can also be radiated to the scapula, neck, hand and so on. Most of the superior trapezius, inferior muscles, coracoid, coracoid, small nodules and acromion, often translocation with the humerus rotation, can cause the thickening and adhesion of the shoulder of the shoulder, and the range of shoulder joint activity gradually narrowed in.176 patients, diagnosed as 52 cases of inferior muscle fasciitis, 50 cases of superior oblique muscle membrane inflammation, 24 cases of frozen shoulder, 12 cases of rotator cuff injury, and levator scapula muscle loss. There were 10 cases of injury, 6 cases of coracocitis, 5 cases of acromial bursitis, 4 cases of acromioclavicular joint injury, 2 cases of posterior scalene fasciitis, 1 cases of supraspinatus fasciitis.
Two, anatomical study: the lateral end of the coracoid is the short head of the biceps brachii and the adhesion of the coracohumerus, the anterior part of the middle part is attached to the tendon of the pectoralis minor, the posterior part is attached to the coracoacroclavicular ligament, the medial part is the coracoclavicular ligament, and the aponeurosis of the subclavicular muscle is attached between the tendon of the pectoralis muscle and the coracoclavicular ligaments. The right side of the tuberous trench is lower than that on the left, and the right right is higher than the right side. On the left side, the right small nodule protruded upward and the hyperplasia was obvious, while the left small nodule was much lower than that of the right. The inferior tubercle of the supraspinatus was covered in the inferior fossa of the scapula, which was a triangular flat muscle and a multi pinnate muscle fiber. The upper lateral part of the muscle was covered by the upper and upper muscle fibers of the deltoid muscle.
Conclusion:
1. Clinically, myofasciitis is the most common soft tissue injury of the shoulder, and the pressure pain point is the most common place in which the pain point is the most obvious. The pain points of the shoulder of these myofasciitis are limited to the diseased muscle, and the pressure pain is 1 more. The pressure pain point of the rotator cuff injury is more than that of the other soft tissue injury of the shoulder, and it is widely distributed. Although the distribution of the two points of the pressure is overlapped, it is different, and the degree of the pressure is different in different stages of the same disease.
Two, the different soft tissue injuries of the shoulder have their own distribution parts and characteristics of their own pressure pain points. The coronoid part is often seen in the frozen shoulder and the coronoid process. The pain points of the rotator cuff injury are more common in the scapular area and between the coronoid process and the small nodule. It is rare in the superior trapezius, the beak process and the inter tubercle sulcus, which are in the frozen shoulder area. Points.
Three, the structure of the shoulder joint is complex, including the structures of the muscles, muscles, tendons, ligaments, sac and joint sac, such as the shoulder joint and its surrounding. In the treatment of the pain point, we should be familiar with the relationship of the local anatomy and be careful about the adjacent vessels.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R686;R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉劍,方玲,許偉東,錢紅;關(guān)節(jié)松動術(shù)治療肩周炎的綜合評定[J];安徽醫(yī)學(xué);2004年03期

2 黃耀生;;當(dāng)歸四逆湯加味治療肩周炎56例[J];浙江中醫(yī)藥大學(xué)學(xué)報;2007年04期

3 杜秀珍;肩關(guān)節(jié)周圍炎綜合治療的效果觀察[J];包頭醫(yī)學(xué)院學(xué)報;2005年01期

4 賈濤,錢齊榮,吳海山;改良前肩峰成形術(shù)治療肩部撞擊癥20例[J];創(chuàng)傷外科雜志;2003年06期

5 于衛(wèi),王春曉;鹽酸乙哌立松治療急性頸肩部軟組織損傷[J];廣東醫(yī)學(xué);2004年12期

6 謝朝暉;中西醫(yī)結(jié)合治療頸肩臂疼痛綜合征療效觀察[J];甘肅中醫(yī);2003年10期

7 孫永安;肩關(guān)節(jié)功能解剖和MRI影像特征[J];國外醫(yī)學(xué)(臨床放射學(xué)分冊);2001年05期

8 劉斌;針刺陽陵泉為主治療肩部軟組織損傷58例[J];湖南中醫(yī)學(xué)院學(xué)報;2000年04期

9 馬兵;按摩治療肩關(guān)節(jié)周圍炎45例[J];河南中醫(yī);2005年01期

10 王巖松,姚猛;肌筋膜扳機點的研究進(jìn)展[J];哈爾濱醫(yī)科大學(xué)學(xué)報;2001年03期

，

本文編號：1839849