冷凍肩－由骨科觀點來探討

An Orthopaedic Study of Frozen Shoulder

陳勝凱(Shen-Kai Chen) ； 林森源(Sen-Yuen Lin) ； 廖潤生(Jun-Sheng Liao)

《The Kaohsiung Journal of Medical Sciences》 4卷1期 (1988/01) Pp. 1-9

https://doi.org/10.6452/KJMS.198801.0001

摘要

冷凍肩(frozen shoulder)是臨床上的一種綜合症狀，其病因雖有不同的學說理論，但以「原因不明」一詞最被人所接受。高雄醫學院骨科三年半來，探討在門診的218位冷凍肩的病人，利用病史、理學檢查、一般X光、關節造影術(arthrography)和關節鏡檢查(arthroscopy)，把冷凍肩病人歸為三類：第一類，假性冷凍肩(pseudo-frozen shoulder)，第二類，原發性冷凍肩(primary frozen shoulder)，第三類，次發性冷凍肩(secondary frozen shoulder)。
假性冷凍肩的X光檢查和關節造影是正常的，顯示肩部骨頭和關節囊沒有病變，鼓勵病人肩部運動，可得快速的良好結果。原發性冷凍肩的關節造影，顯示關節囊明顯收縮和容積變小，尤其以腋下隱窩(axillary recess)為最，利用關節鏡可發現發炎肥大的滑膜絨毛(synovial villi)，關節腔內的粘黏(intraarticular adhesion)，我們以關節鏡裂斷術(arthroscopic brisement)來治療，得到滿意結果。次發性冷凍肩是由於肩部的其他病變而引起冷凍症狀，在我們的病例中，鈣化性肌腱炎(calcific tendinitis)，和肩旋轉肌腱板破裂(rotator cuff tear)是次發性的兩大主因，治療必須找出主因而針對解決。
很多醫師認為冷凍肩可以自癒而忽視了這種會使病人日常生活困擾異常的毛病。目前，我們認為應該以更積極有效的步驟作正確的區別診斷並加速治癒冷凍肩的病患！

並列摘要

Two hundred and eighteen cases of frozen shoulder were analyzed by physical examination, plain X-ray, arthrography and arthroscopy at Kaohsiung Medical College Hospital during a three and half year period. Cases of frozen shoulders were divided into 3 groups: Group I (pseudo-frozen shoulder) included 21 patients who received normal plain X-ray and normal arthrogram. Group II (primary frozen shoulder) included 165 cases. Those patients with restricted capsule as diagnosed by arthrography were also examined with an arthroscope. According to the findings via the arthroscope, our researchers found adhensive capsulitis to be the primary lesion of idiopathic frozen shoulder with secondary changes occuring around the shoulder. It is possible that adhesive capsulitis is the primary lesion of idiopathic frozen shoulder and rotator cuff tendinitis with soft tissue contractures around the shoulder as secondary changes. Different pictures of various stages of frozen shoulder were noted as well. Group III(secondary frozen shoulder), included 32 cases of frozen shoulder secondary to intrinsic shoulder pathology. Rotator cuff tears and calcific tendinitis of the supraspinatus were two major factors on this series. It is suggested that the present conservative management for frozen shoulder may be supplanted by more aggressive procedures, such as arthroscopic brisement.

並列關鍵字

frozen shoulder