Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Windmill Road, Oxford OX3 7LD, UK.
Nat Rev Rheumatol. 2010 Apr;6(4):217-26. doi: 10.1038/nrrheum.2010.25.
Shoulder pain is a common musculoskeletal complaint in the community, which can arise from diverse causes. Regardless of the cause, mild cases can often be effectively treated conservatively, with options including rest, physiotherapy, pain relief and glucocorticoid injections. If conservative strategies fail after a 3-6 month period then surgery might be considered. Generally, the proportion of patients with shoulder pain who require surgery is small. When surgery is considered, a clear diagnosis and structural information from imaging are required. The indications for surgery, and success rate, depend on the specific diagnosis as well as on the individual clinical presentation. Evidence from case series suggest that surgical interventions for shoulder pain are effective when used appropriately. This article outlines the surgical management of the most common painful conditions that affect the shoulder, including impingement, rotator cuff tear, frozen shoulder, osteoarthritis, rheumatoid arthritis and calcific tendonitis.
肩部疼痛是社区中常见的肌肉骨骼疾病,可由多种原因引起。无论病因如何,轻度病例通常可以通过保守治疗有效治疗,包括休息、物理治疗、止痛和糖皮质激素注射。如果经过 3-6 个月的保守治疗后仍未缓解,则可能需要考虑手术治疗。一般来说,需要手术治疗的肩部疼痛患者比例较小。当考虑手术时,需要明确诊断并从影像学获得结构信息。手术的适应证和成功率取决于具体的诊断以及个体的临床表现。来自病例系列的证据表明,手术干预对肩部疼痛是有效的,只要使用得当。本文概述了最常见的影响肩部疼痛的疾病的手术治疗,包括肩峰下撞击综合征、肩袖撕裂、冻结肩、骨关节炎、类风湿关节炎和钙化性肌腱炎。