What is the shoulder joint?

肩膀是一个球窝型关节，允许大范围的活动. Its bony structures includes the upper arm bone (the humerus) and the shallow cavity (the glenoid) of the shoulder blade. 肱骨球(肱骨头)应靠近窝, like a ball bearing in a holder. 肱骨头被关节的衬里(关节囊)固定在臼内。, 被称为韧带和软骨边缘(唇)的囊增厚(图1).

What is shoulder instability?

虽然肩膀有很大的活动范围，但它可能会失去稳定性. 以下是肩部不稳的类型:

Shoulder Dislocation and Subluxation

之前正常的关节受到严重创伤, 肱骨头可强制半脱位或脱位. A shoulder subluxation occurs when the humerus partially slides in and out of place quickly (Figure 2). Shoulder dislocations occur when the humerus comes all the way out of the glenoid (Figure 3). It may fall back into place after time or may need to be put back into place with medical assistance.

The capsule, 韧带或关节唇可以被拉伸, 在肩关节半脱位和脱位时骨撕裂或脱离. When the humeral head is back in place (reduced; Figure 4), these structures can heal in a loose or stretched position that may increase the risk of future episodes of subluxation or dislocation (Figure 5). With each additional episode, further tissue damage can occur, 增加未来不稳定的趋势.

Labral Tear

每当盂唇撕裂或从盂骨脱落时，就会发生肩部不稳定. 这可能发生在肩关节脱位后, 肩部创伤或由于重复运动(如投掷棒球).

Genetic Condition

Some people are born with somewhat loose shoulder ligaments (they have a loose or spacious capsule). For these people, instability can occur without any trauma or following relatively minor injury. Some patients may also have a genetic condition that causes looseness in the joints and predisposes them to develop shoulder instability or weakness.

What are the symptoms of instability?

People with instability of the shoulder joint can sometimes feel the ball of the shoulder come out of its socket or "give way.“这通常与疼痛有关. Often, 让路的发作发生在手臂的特定活动或位置上, 比如扔球或者把手伸到身体后面.

Additional symptoms can include a decreased range of arm/shoulder motion, swelling and bruising.

如何诊断肩关节不稳?

应由医生提供完整的病史和体格检查. The examination includes palpation to check for points of tenderness as well as a determination of range of motion and strength. The degree of shoulder looseness or laxity of the shoulder joint can also be assessed by specific tests during the examination. X-rays are usually done to obtain information about the possible causes of the instability and to rule out other causes of shoulder pain, such as a fracture.

Additional tests, such as a 磁共振成像(MRI)扫描 或染色试验(关节造影)有或没有 computed tomography (CT) scan，有时会进一步评估肩关节的骨骼和组织. 然而，并非所有不稳定患者都需要这些扫描.

How is shoulder instability treated?

肩膀脱臼或半脱位后, 重要的是要让它休息，避免几天的加重活动. If the pain is significant, 比如创伤性脱位, a sling is often used to provide temporary immobilization — shoulder bracing may also be an option for some patients. 一旦疼痛和肿胀消退，就开始进行活动范围练习. 运动改善后可以开始加强锻炼. Typically, the exercise program is done in conjunction with a trained physical therapist.

Applying cold packs or ice bags to the shoulder before and after exercise can help reduce the pain and swelling. 非甾体类抗炎药, which include aspirin, ibuprofen (Motrin, Advil, Nuprin, etc.)或类似布洛芬的药物(如Aleve)可用于减轻疼痛和肿胀. 你有任何问题都应该向你的医生咨询, 由于有许多不同种类的药物可供选择, 它们可能有不同的副作用.

The goal of therapy is to restore shoulder motion and increase the strength of the muscles around shoulder. Strong muscles, especially those of the rotator cuff, 需要保护和防止肩部再脱位或半脱位吗. Once full function of the shoulder has returned, the patient can gradually return to activities.

When would I need surgery?

Despite a course of physical therapy in which full shoulder motion and strength are restored, 肩部可能仍然松动或不稳定. 治疗方案包括1)活动改变和2)手术. Activity modification is primarily an option for patients who experience instability only with certain activities, 比如打篮球或高架球拍运动. In these patients, avoidance of the activity can completely eliminate their episodes of subluxation or dislocation.

Surgical treatment is considered in patients not willing to give up the activities or sports that provoke their episodes, 在日常活动(穿衣)中发生不稳定的患者, sleeping, etc.) or work.

The surgery includes examination of the shoulder under anesthesia to fully assess the extent and direction of the instability while the muscles surrounding the shoulder are completely relaxed. An arthroscope is frequently used to inspect the inside of the shoulder joint to evaluate the joint and its cartilage. The arthroscope allows direct assessment of the condition of the labrum and rotator cuff tendons. In a limited number of select patients in whom the degree of looseness or laxity is relatively mild, 通过关节镜技术可以稳定肩部.

为了纠正严重的不稳定，开放手术通常是必要的. An incision is made over the shoulder and the muscles are moved to gain access to the joint capsule, ligaments and labrum (Figure 6).

然后对这些结构进行修复, 根据手术中发现的组织损伤情况重新附着或收紧(图7)。. The repair can be done with simple sutures or with sutures attached to metal or secured to plastic or absorbable tacks or anchors. These anchors are inserted into the bone and hold the sutures that are used to reattach or tighten the ligaments. 这些锚永久地留在骨头里.

术后康复需要多长时间?

The course of recovery following surgery depends somewhat upon the type of procedure the surgeon performs. 通常，手、手腕和肘部的活动范围在手术后的第二天开始. Most patients can write and use their arm to eat within three to seven days after surgery. A supervised physical therapy program is initiated one to four weeks after the operation. 全身活动通常在6 - 8周后恢复. 体力通常在三个月后恢复. Driving sometimes take several weeks. Return to work or sporting activities depends on the specific nature and demands of that activity but can take up to one year or more for heavy laborers or high-level athletes. With surgery, the chance of recurrence of the instability is low (3 percent to 5 percent) and most patients can return to their previous activities.

Shoulder Injuries | Q&A with Dr. Edward McFarland

Watch on YouTube -

肩部专家Edward McFarland, M.D.，讨论肩关节脱位和半脱位(部分脱位)。. 他讨论了这些肩部损伤的常见原因, 如何治疗，恢复过程如何.