肩周炎的肩周炎的MRMR诊断及诊断及鉴别诊断鉴别诊断王淑丽王淑丽命名命名18721872年年法国学者DuplayDuplay提出“提出“肩关节周围炎”(”(periarthitescapulo-humerale)即“肩周肩周炎炎PeriarthritisoftheShoulder”PeriarthritisoftheShoulder”的名称,并被广泛的名称,并被广泛引用引用肩周炎肩周炎----不明原因的肩痛和活动障碍不明原因的肩痛和活动障碍临床表现临床表现----肩活动度明显下降肩活动度明显下降CodmanCodman于于19341934年将其定义为“冻结肩”年将其定义为“冻结肩”(frozensh(frozenshoulder)oulder)冻结肩冻结肩(frozenshoulder)(frozenshoulder)NeviaserNeviaser于于19451945年通过组织活检发现,此类病例年通过组织活检发现,此类病例存在肩关节囊挛缩、关节囊滑膜下层慢性炎症和存在肩关节囊挛缩、关节囊滑膜下层慢性炎症和纤维化,因而提出“粘连性关节囊炎纤维化,因而提出“粘连性关节囊炎(adhesiveca(adhesivecapsulitis)”psulitis)”的概念的概念目前国外文献已经使用“冻结肩”或“粘连性关目前国外文献已经使用“冻结肩”或“粘连性关节囊炎”这两个名称节囊炎”这两个名称冻结肩(frozenshoulder)粘连性关节囊炎(adhesivecapsulitis)肩周炎肩周炎是一种特定的肩关节囊疾病,并非肩关节周围不明原因肩痛的统称,准确的命名应该是“冻结肩”或“粘连性关节囊炎”陈疾忤,陈世益.肩周炎研究进展.国外医学·骨科学分册,2005,26(2):94-96陆军,王宸.冻结肩的诊疗进展.中华关节外科杂志:电子版,2015,9(4):527-531.冻结肩定义冻结肩定义是一类引起盂肱关节僵硬的粘连性关节囊炎是一类引起盂肱关节僵硬的粘连性关节囊炎表现为肩关节周围疼痛,肩关节各个方向主表现为肩关节周围疼痛,肩关节各个方向主动和被动活动度降低动和被动活动度降低XX线检查无明显异常、偶尔显示骨量减少线检查无明显异常、偶尔显示骨量减少冻结肩的分类冻结肩的分类根据发病特点可分为原发性冻结肩和继发性冻结肩两类原发性冻结肩又称为特发性冻结肩,即尚未发现明确病因继发性冻结肩往往继发于患侧上肢创伤和手术之后的肩痛和关节僵硬等冻结肩的流行病学主要发生在40-60岁,发病率为2%-5%,女性多见左、右肩的发病率无明显差异约有10%的患者在单侧肩关节发病的5年内对侧肩关节也可发病冻结肩发病的高危人群包括较长时间肩部固定或患有系统性疾病糖尿病是男性患者中的危险因素(10-15%)甲状腺疾病是女性患者的危险因素ClassificationoffrozenshoulderClassificationoffrozenshoulderPrimary/idiopathicfrozenshoulderPrimary/idiopathicfrozenshoulder--Anunderlyingetiologyoras--AnunderlyingetiologyorassociatedconditioncannotbeidentifiedsociatedconditioncannotbeidentifiedSecondaryfrozenshoulderSecondaryfrozenshoulder--Anunderlyingetiologyorassociated--AnunderlyingetiologyorassociatedconditioncanbeidentifiedconditioncanbeidentifiedIntrinsicIntrinsic:rotatorcuffdisorders(tendinitisandpartial-thicknes:rotatorcuffdisorders(tendinitisandpartial-thicknessorfull-thicknesstears),bicepstendinitis,orcalcifictendinitisorfull-thicknesstears),bicepstendinitis,orcalcifictendinitissExtrinsicExtrinsic:previousipsilateralbreastsurgery,cervicalradiculo:previousipsilateralbreastsurgery,cervicalradiculopathy,chestwalltumor,previouscerebrovascularaccident,orpathy,chestwalltumor,previouscerebrovascularaccident,ormorelocalextrinsicproblems,includingprevioushumeralshamorelocalextrinsicproblems,includingprevioushumeralshaftfracture,scapulothoracicabnormalities,acromioclavicularaftfracture,scapulothoracicabnormalities,acromioclaviculararthritis,orclaviclefracturerthritis,orclaviclefractureSystemicSystemicDiabetesmellitus,hyperthyroidism,hypothyroidisDiabetesmellitus,hyperthyroidism,hypothyroidism,hypoadrenalismm,hypoadrenalismZuckermanJ...