Simon Lauren Meryl, Nguyen Van, Ezinwa Ngozi Margarete
Loma Linda University, Loma Linda, California.
Am Fam Physician. 2023 May;107(5):503-512.
Acute shoulder pain lasting less than six months is a common presentation to the primary care office. Shoulder injuries can involve any of the four shoulder joints, rotator cuff, neurovascular structures, clavicle or humerus fractures, and contiguous anatomy. Most acute shoulder injuries are the result of a fall or direct trauma in contact and collision sports. The most common shoulder pathologies seen in primary care are acromioclavicular and glenohumeral joint disease and rotator cuff injury. It is important to conduct a comprehensive history and physical examination to identify the mechanism of injury, localize the injury, and determine if surgical intervention is needed. Most patients with acute shoulder injuries can be treated conservatively using a sling for comfort and participating in a targeted musculoskeletal rehabilitation program. Surgery may be considered for treating middle third clavicle fractures and type III acromioclavicular sprains in active individuals, first-time glenohumeral dislocation in young athletes, and those with full-thickness rotator cuff tears. Surgery is indicated for types IV, V, and VI acromioclavicular joint injuries or displaced or unstable proximal humerus fractures. Urgent surgical referral is indicated for posterior sternoclavicular dislocations.
持续时间少于六个月的急性肩部疼痛是基层医疗诊所常见的就诊症状。肩部损伤可累及四个肩关节中的任何一个、肩袖、神经血管结构、锁骨或肱骨骨折以及相邻的解剖结构。大多数急性肩部损伤是跌倒或接触性和碰撞性运动中的直接创伤所致。基层医疗中最常见的肩部病变是肩锁关节和盂肱关节疾病以及肩袖损伤。进行全面的病史采集和体格检查以确定损伤机制、定位损伤并判断是否需要手术干预非常重要。大多数急性肩部损伤患者可通过使用吊带以缓解疼痛并参与有针对性的肌肉骨骼康复计划进行保守治疗。对于活跃个体的中三分之一锁骨骨折和III型肩锁关节扭伤、年轻运动员的首次盂肱关节脱位以及肩袖全层撕裂患者，可考虑手术治疗。IV型、V型和VI型肩锁关节损伤或移位或不稳定的肱骨近端骨折需要手术治疗。后胸锁关节脱位需要紧急手术转诊。
