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of acute shoulder dislocation athletic training 急性肩关节脱位运动训练管理课件

of acute shoulder dislocation athletic training 急性肩关节脱位运动训练管理课件

ID：19453860

大小：1.88 MB

页数：25页

时间：2018-10-02

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1、ManagementofAcuteShoulderDislocationAnoverviewHeatherCampionSportsMedicineConference1/22/08IncidenceShoulderisthemostcommonlydislocatedjointTraumaticDislocationsAnterior96%Posterior2-4%Diversegroupofpatientsexperiencedislocations;MandFyoungandoldactiveandinactiveAnatomicConsiderat

2、ionGlenohumeralstabilizationmechanismsPassive:jointconformity,vacuumeffect,ligamentousandcapsularrestraints,labrumActive:longheadofBicepsandRotatorCuffPathoanatomyofshoulderdislocationsBankartLesion:avulsionofanteroinferiorlabrumHill-SachsLesion:posterolateralhumeralheaddefectAsso

3、c.RCT:morecommoninolderpatientsClinicalEvaluationPE:Prominentacromion,sulcussign,palpablehumeralheadanteriorlyNeurointegrityofaxillaryandmusculcutaneousnervesApprehensionTest:reproducessenseofinstabilityandpaininshoulderreducedpriortoexamRadiographicEvaluationAPvstrueAPAxillaryvsV

4、alpeauAxillarySpecialViews:WestPointaxillary:forvisualizationofglenoidrimHill-Sachview:internalrotationviewStrykerNotch:view90%ofposterolateralhumeralheadManagementPre-MedicationReductionManeuversPost-ReductionImmobilizationPre-MedicationMethodsofPremedicationpriortoReductionNoneI

5、ntraarticularLidocaineIVSedationSupraclavicularBlockSuprascapularBlockIVSedationvsIntraarticularLidocaineInjectionLevel1RCT:MilleretalJBJS2002ProspectiveRandomizedstudyputisolatedshoulderdislocationpatients(#30)into2groupsVarietyofOutcomeMeasures:ReductionSuccessComplicationsPainT

6、imetoreduce/TimeintheERCostIVSedationvsIntraarticularLidocaineInjectionNosignificantdifferencebetween:ReductionSuccessReductionTimePainScoreStatisticalSignificance:PtstxwithintraarticularLidocainelefttheERearlierFewerComplicationsLowerCostwithLidocaineIVSedationvsIntraarticularLid

7、ocaineInjectionIntra-articularLidocaineInjectionisPreferredoverIVSedationReductionManeuversIsthereanIdealMethodforReduction?Over24TechniquesDescribedMostCommonTechniquesKocher(71-100%)ExternalRotation(78-90%)Milch(70-89%)Stimson(91-96%)Traction/CountertractionScapularManipulation(

8、79-96%)KocherManeuverArmisadducte

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