肩峰下滑囊炎 Sub-acromial bursitis Ling Lii Chau I11008950

概论Introduction 肩峰下滑液囊在临床上意义最大。 此滑囊炎的特点多不是原发性的，而是继发于邻近组织的病变，尤以岗上肌的损伤、退行性变、钙盐沉积和肌腱 袖破裂的影响最大，如钙化性岗上肌腱炎，在急性期能破溃至滑囊内引起急性滑囊炎，称钙化性滑囊炎。当然，也可由直接或间接的外伤所引起。  肩关节外展、内旋时，此滑囊随肱骨大结节滑入肩峰的下方而不能被触到

Sub-acromial brusitis plays an significant role in clinical session It is not primary cause but is secondary causes due to adjacent tissue lesions especially injury of supraspinatus tendon, degeneration, calcium deposition and cuff tendon ruptures like calcific supraspinatus tendinitis, ulceration to bursa during acute stage lead to acute brusitis are known as calcific brusitis. Also can be caused by direct or indirect trauma. Shoulder abduction, internal rotation, bursa follow greater tuberosity of humerus and slipped to downward of acromion and thus unable to touch

肩部的应用解剖Applied anatomy of the shoulder 肩峰下 别名 位置 肩峰下滑液囊 三角肌下滑液囊 三角肌下 位于肩峰，喙肩韧带与冈上肌之间 三角肌下滑液囊位于三角肌上部与冈上肌腱止点之间，两囊在成年人一般互通为一体。

滑利肩关节，减少磨损 在肩峰外展时，使大结节在肩峰下运动灵活 肩峰下滑液囊 别名 肩峰下关节

Subacromial bursitis also called deltoid muscle brusitis, because of the synovial divide into subacromial and subdeltoid. Subacromial bursa located at acromial bone, in between coracoacromial ligament between the supraspinatus. Deltoid muscle bursa located at upper point of deltoid and supraspinatus tendon.Both bursa normally are together in adult. Subacromial bursa is the largest human anatomy synovial, which profits slip shoulder, reduce friction, not easy become weak. During shoulder abduction, it provides greater tuberosity in subacromial flexible movement, so are beneficial to shoulder activities, also called the subacromial joint.

肩部周围的肌肉有内外两层，外层为三角肌和大圆肌，内层为肌腱袖，肩峰下滑液囊介于此二层之间，以保证肱骨大结节顺利地通过肩峰下进行外展活动

The muscles around the shoulder are divided into internal and external layers, external layer consist of deltoid and teres major, internal layer consist of cuff tendon, subacromial bursa located between the two layer, in order to ensure smooth abduction of greater tuberosity of humerus

病因病理Causes and Pathogenesis 肩峰下滑液囊炎可因直接或间接外伤所引起，但本病大多继发于肩关节周围的软组织损伤和退行性变，尤以滑液囊底部的冈上肌腱的损伤、炎症、钙盐沉积为最常见。 Due to shoulder joint surrounding lesion and degeneration 肩峰下滑液囊组织介于肩峰与肱骨头之间，长期反复摩擦可致损伤。滑膜受到损伤后，发生充血、水肿和滑液分泌增多，形成滑液囊积液。日久慢性炎症残存，不断刺激，滑膜增生，囊壁增厚，滑液分泌减少，组织粘连，从而影响肩关节外展，上举及旋转活动prolonged recurrent friction causing lesions. When synovial injured, lead to blood stagnation or edema or increase secretion of synovial fluid causing fluid accumulation in synovial capsule. Chronic inflammation of synovial joint lead to synovial hyperplasia, wall thickening, synovial fluid secretion, tissue adhesion, thus affecting the abduction, adduction and rotation activity

临床表现与诊断Clinical Manifestation and Diagnosis 疼痛 运动受限 局限性压痛 痛向肩胛部、颈、手等处放射 疼痛逐渐增剧，夜间痛较著，常痛醒 肩外展外旋时痛加重

Pain, limited motion and limited tenderness is the main manifestation, increase pain, aggravated at night and woke up due to pain especially shoulder abduction and external rotation, pain radiate to scapular, neck and hands

压痛点多在肩关节、肩峰下、大结节等处，常可随肱骨的旋转而移位，当滑囊肿胀或积液时，在肩关节区域或三角肌范围内都有压痛。为减轻疼痛病人常使肩处于内收、内旋位，随着滑囊壁的增厚和粘连，肩关节活动范围逐渐缩小至完全消失。晚期可见肩胛带肌的萎缩。 Tenderness point normally at shoulder, subacromial, greater tubercle and location will change according to the rotation of humerus. When bursa is wollen or fluid is accumulated inside it, there will be pain surrounding it. To relieve the pain normally internal rotation will helps. Later stage there will be degenaration of shoulder girdle muscle

X线检查偶可见岗上肌的钙监沉着X ray can see calcification on supraspinatus tendon 。 肩峰下滑囊穿刺，依据积液量及性状有助于诊断病变性质和程度。 Subacromial bursa injection to determine the quantity of fluid accumulation to help to diagnose with disease’s nature and degree

治疗Treatment （一）手法治疗 Hand Manipulation 适用于亚急性期或慢性期。用旋肩的手法（见肩部扭挫伤手法治疗）使该滑液囊在肩峰、三角肌与肱骨头之间进行间接按摩，促进炎症吸收与粘连的松解。 Suitable in sub-acute stage or chronic stage. Use shoulder rotation manipulation to allow synovial joint indirectly massage at subacromial and deltoid muscle and humerus to allow absorption of secretion of inflammation.

（二）固定方法Fixation 急性期颈吊带休息3 －7天Neck hanging during acute stage and rest for 3 to 7 days （三）练功疗法Basic exercise （四）药物治疗Medicational treatment （五）其他疗法 Other treatment

（三）练功疗法Basic exercise 耸肩环绕shrug rotation 加强关节功能 马桩式站立  standing on the stake 下身不动，全臂用力，两手自胸前由内下→前上→外后→下内翻转，先是前臂旋后手心向内，继是前臂旋前手心向外，方向相反，左起右落。 坐靠背椅仰卧练习sitting in supine at chair 利用肢体重量加上地心引力，或双指相嵌，手心翻转向上，左右摆动，按向上向后的要求，利用练习的准确程度与渐增来增进疗效

（四）药物治疗Medicational Treatment 1．内服药   Ingestion of medicine  （1）瘀滞证Stasis and stagnation syndrome： 主证：多见于早期，肩部肿胀，疼痛拒按，夜间疼痛尤为明显，局部可触及波动感之肿块。舌质暗红，苔薄黄，脉弦。，seen in early stage with shoulder region swollen and pain and refuse pressing and pain obvious at night with palpable mass. Dark red tongue with thin yellow coating and wiry pulse 治法：活血通络止痛activate blood free collaterals to stop pain 方剂：舒筋活血汤Modified shu jin huo xue tang。

（2）虚寒证Deficiency cold syndrome： 主证：多见于后期，肩部疼胀疼痛，劳累后疼痛加重，畏寒喜温，神疲乏力，可触及质软之肿块。舌质淡苔薄白，脉沉细。，方用seen in later stage with shoulder region distension pain and pain aggravated after overstrain, fear cold and prefer warm, lassitude, pale tongue with thin white coating and submerged thin pulse 治法：温经散寒，养血通络warm meridian to dispel cold, nourish blood to free collaterals 方剂：当归四逆汤加减Modified Dang gui si ni tang。

 2．外用药External application of medicine  追风壮骨膏、四生散zhui feng zhuang gu gao, si sheng san

（五）其他疗法 1．拔罐 Cupping 用于陈伤，可除去恶血，或拔去风寒湿邪，有助气血流通，可促进伤筋恢复。 2．灸法Moxibustion 温和灸每天2次，每次20－30分钟。 3．封闭疗法Close treatment 滑液囊肿大者，可先行穿刺抽液，囊内注射醋酸强的松龙25mg加2％普鲁卡因2ml，每周1次，约2－3次。 4．手术疗法 Surgery treatment经长期非手术疗法仍不见效，疼痛仍剧烈，严重影响工作者，可考虑手术治疗。手术包括滑液囊切除和清除同上肌腱中的钙化部分。如有肩关节外展功能受影响时，亦可将肩峰切除。

THANK YOU!!