Ikai T, Tei K, Yoshida K, Miyano S, Yonemoto K
Tokyo Metropolitan Rehabilitation Hospital, Japan.
Am J Phys Med Rehabil. 1998 Sep-Oct;77(5):421-6. doi: 10.1097/00002060-199809000-00012.
Shoulder subluxation in hemiplegic patients has been recognized as a difficult problem to manage. In the study contained herein, our aims are to evaluate shoulder subluxation, to clarify if shoulder subluxation causes pain, and to discuss the treatment of shoulder subluxation. The study included 75 hemiplegic patients with shoulder subluxation. Each patient was evaluated for the degree of shoulder pain, motor recovery of the upper limb, and shoulder range of motion. Some indexes for evaluating subluxation were measured with radiographs of the shoulders. Arthrograms of the affected shoulder joint were taken in 23 patients. The following results were found: (1) shoulder pain was significant more frequently in left hemiplegia; (2) vertical disparity was strongly correlated with discrepancy of the descendant ratio; (3) severe inferior subluxation had a tendency to show medial displacement of the humeral head; (4) there were correlations between shoulder pain and shoulder range of motion, especially external rotation; (5) adhesive changes in the arthrograms were seen in most subjects. These results indicate that there is no relation between shoulder subluxation and pain, and adhesive capsulitis is a main cause of shoulder pain. We conclude that correct positioning and shoulder range of motion exercises are advisable in hemiplegic patients with shoulder subluxation.
偏瘫患者的肩关节半脱位已被公认为是一个难以处理的问题。在本研究中，我们的目的是评估肩关节半脱位，阐明肩关节半脱位是否会引起疼痛，并探讨肩关节半脱位的治疗方法。该研究纳入了75例患有肩关节半脱位的偏瘫患者。对每位患者的肩部疼痛程度、上肢运动恢复情况以及肩关节活动范围进行了评估。通过肩部X线片测量了一些评估半脱位的指标。对23例患者的患侧肩关节进行了关节造影。结果如下：（1）左侧偏瘫患者肩部疼痛更为常见；（2）垂直差异与下降比例的差异密切相关；（3）严重的下脱位倾向于显示肱骨头的内侧移位；（4）肩部疼痛与肩关节活动范围之间存在相关性，尤其是外旋；（5）大多数受试者的关节造影显示有粘连改变。这些结果表明肩关节半脱位与疼痛之间没有关系，粘连性囊炎是肩部疼痛的主要原因。我们得出结论，对于患有肩关节半脱位的偏瘫患者，建议进行正确的体位摆放和肩关节活动范围锻炼。
