肩部损伤

jacky

• Shoulder Injuries
• Shoulder problems in a young, athletic population often include one of two diagnoses: shoulder instability or shoulder impingement.
• Shoulder Instability
• Shoulder instability includes either a dislocation or subluxation. Dislocation of a joint means that the two surfaces completely separate. In a subluxation, the joint surfaces come only partially apart. Often an accident or traumatic force is the cause of shoulder instability. However, there is a group of people with generalized "loose shoulders" who may feel their shoulder "come out" with relatively simple daily activities, such as reaching for a seatbelt or sleeping with their arms overhead. In general, these individuals often experience instability in both shoulders in contrast to the one sided instability experienced by those who have suffered a traumatic accident.
  

This picture is provided courtesy of Medical Multimedia Group.

This picture is provided courtesy of Medical Multimedia Group.

• Regardless of whether one's instability is traumatic or atraumatic, in approximately 90% of cases the instability is in an antero-inferior direction, i.e. the humeral head (ball) slips forward and down out of the glenoid (socket). When someone suffers their first dislocation, they experience significant pain, they will typically hold their arm down by their side unable to move their shoulder, and the deltoid area may appear flatter when compared to the opposite shoulder. In general, with each subsequent episode of instability, less trauma is required to separate the joint surfaces. Subsequent dislocations typically produce less pain, less disability, and a faster recovery time. However, the unfortunate consequence is a shoulder that may have once required significant trauma to dislocate can now become unstable with simple daily tasks.
• After an episode of instability, the ligaments of the shoulder rarely return to their pre-injury length. Therefore, the hallmark of treatment for instability lies in strengthening exercises for the rotator cuff. For if the rotator cuff is strong, it can successfully steer the ball on the socket decreasing the reliance of ligamentous stability. Rotator cuff strengthening exercises would include both internal and external rotation exercises as well as resisted elevation exercises.
• Historically, individuals with atraumatic shoulder instability have done very well with rehabilitation alone. When one suffers a traumatic dislocation, often there is an associated tearing of the ligaments or the labrum that cannot be overcome by a strengthening program. This may account for the high recurrence rate of instability in adolescents- 60-90% of those who suffer their first dislocation under the age of 20 will have subsequent episodes of instability. If instability persists after a 4-6 week trial of strengthening, surgery is often necessary to either repair the cartilage tear (Bankart repair) or to tighten the ligaments of the shoulder (Capsular Shift). The rehabilitation program after either of those two procedures is very similar.
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This picture is provided courtesy of Medical Multimedia Group.

This picture is provided courtesy of Medical Multimedia Group.

• Shoulder Tendonitis/Impingement
• Another common athletic shoulder injury is rotator cuff tendonitis or impingement. As stated earlier, the rotator cuff is a group of four muscles that surround the humeral head (ball). In general, these muscles are not strengthened with a typical weight lifting routine and so they are often weaker than the primary movers of the shoulder. This muscle imbalance may eventually lead to inflammation of the rotator cuff (rotator cuff tendonitis). Once the tendon becomes inflamed, it may swell and become pinched between the humeral head (ball) and the acromion process of the shoulder blade. Whether the rotator cuff tendon is merely inflamed or being impinged, the signs and symptoms are relatively similar. Individuals typically complain of pain with overhead or repetitive motions or with heavy lifting. In general, they have little pain with simple daily tasks with the arm down by the side, although their symptoms may progress to this point if left untreated.
  

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• Because rotator cuff tendonitis and shoulder impingement lie on a continuum, the treatment for these two conditions is similar. The primary goals of a rehabilitation program are to reduce pain and then to slowly improve the pain-free range of motion. Pain reduction may be accomplished with the use of superficial modalities such as heat or ice or with medications. If the individual is involved in a supervised rehabilitation program, physical modalities such as ultrasound or electrical stimulation may also be used. Once pain has begun to resolve, stretching exercises are used to improve the overall range of motion and specifically target the posterior (back) aspect of the shoulder. Once range of motion has been restored, the goal becomes strengthening of the rotator cuff to correct any strength imbalances and prevent re-injury.
• Rotator Cuff Tears
• A true tear in the rotator cuff typically affects only those over 40 years of age. Certainly, there are well publicized rotator cuff tears in the shoulders of professional baseball pitchers, but the amount of force and number of repetitions that they expose their shoulders to is obviously greater than the population at large. A typical rotator cuff tear is one that begins without incident as a result of minor trauma throughout an individual's life. This process is often hastened by a traumatic injury to the shoulder-fall on the outstretched arm, overexertion, heavy lifting, etc.
  

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• Depending on the size of the rotator cuff tear, the symptoms may range from pain with overhead activities (mimicking impingement) or may render the individual unable to actively lift even the weight of their arm. Depending upon the amount of pain and disability the rotator cuff tear causes, the treatment of choice may be simple rehabilitation exercises or may involve surgical reattachment of the rotator cuff.
  

This picture is provided courtesy of Medical Multimedia Group.

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