肩部常见软组织压痛点的临床与解剖学研究

发布时间：2018-05-03 19:49

本文选题：肩部 + 压痛点　；参考：《南方医科大学》2008年硕士论文

【摘要】： 目的: 一、明确肩部软组织损伤性疾病常见压痛点的分布规律及临床特征,为肩痛患者的诊治提供更为详实的临床资料。二、为肩部常见疾病的体表定位、手法操作和扳机点注射等治疗提供解剖形态学资料及应用基础。方法: 一、临床研究:选取54例主诉肩部疼痛的患者,明确诊断,分别依次行局部压痛点检查及解剖定位并进行局部压痛的疼痛量化评分(visual analogue scale,VAS)。所得计量资料用均数±标准差((?)±s)表示,用SPSS13.0统计软件对数据行方差分析。明确其疼痛的部位、性质、持续时间、牵涉痛的范围和伴随症状以及以往诊治情况等。二、解剖学研究:选取6具成人防腐尸体,观测肩部,尤其是常见痛点的解剖形态学结构特征,毗邻关系以及血管、神经等走行及分布特征。同时注意观察肩部常见穴位与痛点的解剖学关系。结果: 一、临床研究:肩部疼痛的患者较为多见。由于病因不同患者的症状也各有特点。但多以疼痛、运动受限和局限性压痛为主要症状,有时可表现疼痛逐渐增加,夜间痛较著,尤以肩外展外旋时疼痛加重,亦可向肩胛部、颈、手等处放射。压痛点多在上斜方肌、冈下肌、喙突、小结节和肩峰下等处,常可随肱骨的旋转而移位,可导致肩部滑囊壁的增厚和粘连,肩关节活动范围逐渐缩小。176例患者中,诊断为冈下肌筋膜炎52例,上斜方肌筋膜炎50例、冻结肩24例、肩袖损伤12例、肩胛提肌损伤10例、喙突炎6例、肩峰下滑囊炎5例、肩锁关节损伤4例、后斜角肌筋膜炎2例、冈上肌筋膜炎各1例。二、解剖学研究:喙突外侧端为肱二头肌短头及喙肱肌附着,中部前侧半为胸小肌肌腱附着,后侧半为喙肩韧带附着,内侧部为喙锁韧带,在胸小肌肌腱及喙锁韧带之间尚有锁骨下肌的腱膜附着。结节间沟宽度右侧低于左侧,深度右侧高于左侧。右侧小结节向上突起,增生明显,而左侧小结节则多低平,结节间沟较右侧浅。冈下肌覆盖于肩胛骨冈下窝内,为三角形扁肌,肌纤维呈多羽状。该肌的上外侧部被三角肌后上部肌纤维所掩盖。结论: 一、临床上,肌筋膜炎是肩部最常见的软组织损伤性疾病,其所致的压痛点也是发生率最高,压痛最明显的部位。这些肌筋膜炎所致的肩部压痛点仅局限于该病变肌肉,且压痛多为1处,临床上多根据压痛点即可做出大致的诊断。冻结肩和肩袖损伤的压痛点较肩部其他软组织损伤性疾病的压痛点多,且广泛,二者压痛点的分布虽多有重叠,但也有不同。同一疾病的不同阶段,其压痛程度也有所不同。二、肩部不同软组织损伤性疾病具有各自的压痛点分布部位和特征。喙突部出现压痛多见于冻结肩和喙突炎。肩袖损伤的压痛点较多,多见于肩胛区以及喙突与小结节之间等处。少见于上斜方肌、喙突和结节间沟等处,这是与冻结肩相区分之处。三、肩关节的结构比较复杂,包括肩关节及其周围的肌肉、肌腱、韧带、滑囊和关节囊等结构,在对痛点进行封闭等治疗时,应熟悉局部解剖关系,对于毗邻血管、神经部位注射时需加以小心。
[Abstract]:Objective:
First, to clarify the distribution and clinical characteristics of common tenderness points of shoulder soft tissue injuries, and provide more detailed clinical data for the diagnosis and treatment of shoulder pain patients.
Two, provide anatomical and morphological data and applied basis for the treatment of shoulder diseases such as body surface positioning, manipulation and trigger point injection.
Method:
First, clinical study: 54 patients who complained of shoulder pain were selected to make a definite diagnosis, and the local pressure point examination and anatomic location were performed in turn and the pain quantification score of local pressure pain (visual analogue scale, VAS). The measured data were expressed with mean standard deviation ((?) + s), and the variance analysis of data lines was made by SPSS13.0 software. The location, nature, duration of pain, the range of pain involved and accompanying symptoms, as well as previous diagnosis and treatment, were analyzed.
Two, anatomical study: 6 adult cadavers were selected to observe the anatomical structure features of the shoulder, especially the common pain points, the adjacent relationship and the characteristics of the blood vessels and nerves, and the anatomical relationship between the common acupoints and the pain points.
Result:
One, clinical study: the patients with shoulder pain are more common. The symptoms of the patients with different causes are also characterized. But the main symptoms are pain, limited movement and limited pressure pain. Sometimes the pain increases gradually, the pain is more at night, especially when the abduction of the abductor is aggravated, and it can also be radiated to the scapula, neck, hand and so on. Most of the superior trapezius, inferior muscles, coracoid, coracoid, small nodules and acromion, often translocation with the humerus rotation, can cause the thickening and adhesion of the shoulder of the shoulder, and the range of shoulder joint activity gradually narrowed in.176 patients, diagnosed as 52 cases of inferior muscle fasciitis, 50 cases of superior oblique muscle membrane inflammation, 24 cases of frozen shoulder, 12 cases of rotator cuff injury, and levator scapula muscle loss. There were 10 cases of injury, 6 cases of coracocitis, 5 cases of acromial bursitis, 4 cases of acromioclavicular joint injury, 2 cases of posterior scalene fasciitis, 1 cases of supraspinatus fasciitis.
Two, anatomical study: the lateral end of the coracoid is the short head of the biceps brachii and the adhesion of the coracohumerus, the anterior part of the middle part is attached to the tendon of the pectoralis minor, the posterior part is attached to the coracoacroclavicular ligament, the medial part is the coracoclavicular ligament, and the aponeurosis of the subclavicular muscle is attached between the tendon of the pectoralis muscle and the coracoclavicular ligaments. The right side of the tuberous trench is lower than that on the left, and the right right is higher than the right side. On the left side, the right small nodule protruded upward and the hyperplasia was obvious, while the left small nodule was much lower than that of the right. The inferior tubercle of the supraspinatus was covered in the inferior fossa of the scapula, which was a triangular flat muscle and a multi pinnate muscle fiber. The upper lateral part of the muscle was covered by the upper and upper muscle fibers of the deltoid muscle.
Conclusion:
1. Clinically, myofasciitis is the most common soft tissue injury of the shoulder, and the pressure pain point is the most common place in which the pain point is the most obvious. The pain points of the shoulder of these myofasciitis are limited to the diseased muscle, and the pressure pain is 1 more. The pressure pain point of the rotator cuff injury is more than that of the other soft tissue injury of the shoulder, and it is widely distributed. Although the distribution of the two points of the pressure is overlapped, it is different, and the degree of the pressure is different in different stages of the same disease.
Two, the different soft tissue injuries of the shoulder have their own distribution parts and characteristics of their own pressure pain points. The coronoid part is often seen in the frozen shoulder and the coronoid process. The pain points of the rotator cuff injury are more common in the scapular area and between the coronoid process and the small nodule. It is rare in the superior trapezius, the beak process and the inter tubercle sulcus, which are in the frozen shoulder area. Points.
Three, the structure of the shoulder joint is complex, including the structures of the muscles, muscles, tendons, ligaments, sac and joint sac, such as the shoulder joint and its surrounding. In the treatment of the pain point, we should be familiar with the relationship of the local anatomy and be careful about the adjacent vessels.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R686;R322

【参考文献】