肩关节检查法.pptVIP

Painful arc. Test 要求： 前屈上举肩关节（肩胛骨平面） 先完全上举后，再放下 注意患者肢体有无旋转，以避免或减少疼痛 非特异性检查 Drop arm test 肩关节被动外展120度左右 维持位置，慢慢放下双臂 突然下降伴有疼痛即阳性 Indications Rotator Cuff Tear Suspected Technique Examiner passively abducts shoulder to 160 degrees Patient attempts to slowly adduct arm to resting position at side Interpretation: Signs of Rotator Cuff Tear Arm drops to side quickly and not smoothly Gentle tap over abducted arm may force arm to give way Efficacy Test Sensitivity: 27% Test Specificity: 88% 特异性检查 冈上肌检查：Jobe test，外旋延迟试验 冈下肌检查：外旋延迟试验 肩胛下肌检查： Lift-off test Press Belly test 内旋延迟试验 肱二头肌腱损伤（SLAP损伤） O’brien test Speed test 冈上肌检查 Jobe supraspinatus test 外展90度，前屈30度（肩胛骨水平） （拇指向下）内旋时冈上肌肌束力线成一直线 抗阻力出现无力疼痛为阳性 Jobe supraspinatus test Jobe’s test. This is to test the muscle. The examiner places the arm in a 90° abduction in the plane of the scapula and in internal rotation. He will then ask the patient to resist the pressure and determine the muscular strength of the supraspinatus. Pain will often prevent this test from being carried out correctly. 冈下肌检查 肘关节屈曲90度 不要碰到躯干 外旋90度，前屈30度（排除三角肌影响）对抗阻力 无力为阳性 冈下肌检查 外旋迟滞试验 屈肘前伸肩关节30度，被动外旋肩关节，嘱维持住位置，放手后，若有肩袖破裂，外旋的肩关节会回弹。 回弹超过手掌范围为阳性。 肩胛下肌检查 Lift-off test 主动内旋后伸肩关节 远离躯干 对抗阻力 无力者为阳性 肩胛下肌检查 Press belly test the press-belly test be carried out comparatively by pressing on the elbows to quantify the strength of the supraspinatus muscle. 肩胛下肌检查 内旋迟滞试验 屈肘后伸肩关节，检查者一手扶住病人肘关节，另一手握住病人腕关节，将其向后拉离病人背部，嘱病人维持住位置。 放手回弹超过一个手掌范围为阳性。 肩袖损伤的检查 检查冈上肌和冈下肌 敏感性 特异性 Jobe test + 外旋迟滞试验 + 检查肩胛下肌 Lift-off + 内旋迟滞试验 + + 迟滞试验检出率高，但受患者活动度的限制 肱二头肌肩胛盂损伤的检查 O’brien test Speed test Yargason sign O’brien test O’Brien’s test consists of asking a patient whose arm, elbow in extension, is taken to anterior elevation at 90°, slightly in adduction (15°) and internal rotation (thumb down) then external rotation (thumb up) to resist a superoinferior pressure. The test is positive if pain ap