Bhargav Divya, Murrell George A
Sports Medicine and Shoulder Service, Orthopaedic Research Institute, University of New South Wales, St George Hospital Campus, Sydney, New South Wales.
Aust Fam Physician. 2004 Mar;33(3):143-7.
Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder').
This article summarises the functional anatomy of the shoulder joint, the pathology of the conditions that lead to shoulder stiffness, and methods to differentiate them.
Clinical history and examination is effective in differentiating rotator cuff tears, impingement and frozen shoulder. Restriction of glenohumeral joint motion, particularly in external rotation, with no abnormality on X-ray is strongly suggestive of the diagnosis of frozen shoulder. Plain true anteroposterior X-rays are important to identify glenohumeral joint arthritis. Ultrasound is often helpful for confirming or denying rotator cuff tears when there is doubt on the clinical examination.
肩部疼痛和僵硬是常见的主诉，尤其是在40至80岁的年龄组中。导致肩部疼痛、僵硬的原因有多种，但在人生的第五个十年中最常见的原因是特发性关节囊炎（“冻结肩”）。
本文总结了肩关节的功能解剖、导致肩部僵硬的病症的病理学以及鉴别这些病症的方法。
临床病史和检查对于鉴别肩袖撕裂、撞击综合征和冻结肩很有效。盂肱关节活动受限，尤其是外旋受限，而X线无异常，强烈提示冻结肩的诊断。普通的真正前后位X线片对于识别盂肱关节关节炎很重要。当临床检查存在疑问时，超声通常有助于确认或排除肩袖撕裂。
