Mahaffey B L, Smith P A
University of Missouri-Columbia School of Medicine, USA.
Am Fam Physician. 1999 May 15;59(10):2773-82, 2787.
The term "shoulder instability" constitutes a spectrum of disorders that includes dislocation, subluxation and laxity. Anterior instability is the most common form of glenohumeral instability and may be associated with nerve injury. The diagnosis of anterior, posterior or multidirectional instability is based on a thorough history and physical examination that includes specific provocative maneuvers. The load-and-shift test, the relocation test, the drawer test, the sulcus test and the anterior apprehension test are useful for assessment of the shoulder. Radiographic studies should include special views to delineate specific lesions, such as a Bankart lesion and a Hill-Sachs defect. Early surgical intervention may be a consideration, especially in younger patients. Recent studies suggest that surgical intervention after the first dislocation may reduce the rate of recurrence. Rehabilitation is accomplished in four phases, beginning with rest and pain control and proceeding to isometric and isotonic exercises. The goal is for the patient to reach 90 percent strength in the injured shoulder compared with the uninjured shoulder.
“肩部不稳定”一词涵盖了一系列病症,包括脱位、半脱位和松弛。前向不稳定是肩肱关节不稳定最常见的形式,可能与神经损伤有关。前向、后向或多向不稳定的诊断基于详尽的病史和体格检查,其中包括特定的激发性动作。负荷移位试验、复位试验、抽屉试验、沟试验和前向恐惧试验对肩部评估很有用。影像学检查应包括特殊视图以描绘特定病变,如Bankart损伤和Hill-Sachs缺损。早期手术干预可能是一种选择,尤其是在年轻患者中。最近的研究表明,首次脱位后进行手术干预可能会降低复发率。康复分四个阶段完成,从休息和控制疼痛开始,然后进行等长和等张运动。目标是使患者受伤肩部的力量达到未受伤肩部的90%。