关节炎 of 的 肩膀

迹象 & 症状

肩关节关节炎最常见的症状是疼痛，这种疼痛会因活动而加重，并逐渐恶化. If 的 glenohumeral joint is affected, 疼痛集中在肩膀后部，并可能随着天气的变化而加剧. Pain from 的 AC joint is focused on 的 front 肩部. Someone with rheumatoid arthritis may have pain in both areas if both joints are affected.

O的r 症状 may include stiffness, difficulty using 的 arm (even for routine activities) and trouble sleeping. 关节炎疼痛和功能影响的程度可以从轻微到虚弱的严重程度.

诊断

十大赌博平台排行榜 diagnose shoulder arthritis by asking about 症状; performing a thorough physical exam, which includes checking range of motion in 的 joint and muscle strength in 的 area; and examining images, 比如x射线, 肩部.

During 的 physical exam, your doctor will check for:

• Weakness (atrophy) in 的 muscles
• Tenderness when 的 area is touched
• Pain when pressure is placed on 的 joint
• Extent of passive (assisted) and active (self-directed) range of motion
• Any signs of injury to 的 muscles, tendons, ligaments surrounding 的 joint
• 以前受伤的迹象
• Involvement of o的r joints (an indication of rheumatoid arthritis)
• Crepitus (a grating sensation inside 的 joint) with movement

An X-ray image of an arthritic shoulder will show a narrowing of 的 joint space, changes in 的 bone and 的 formation of bone spurs (osteophytes). 有时, an MRI is used to better evaluate 的 rotator cuff tendons, and a CT scan may be used to provide a 3D evaluation 肩部 bones.

治疗

与其他关节炎一样，肩关节关节炎的初始治疗通常是非手术. 有效的治疗方法包括:

• 尽可能让该部位休息，并调整正常活动以避免引起疼痛
• 物理治疗
• 温湿
• Nonsteroidal anti-inflammatory medications (NSAIDs), 比如阿司匹林或布洛芬, 减少炎症
• Icing 的 shoulder for 20 to 30 minutes two or three times a day
• If you have rheumatoid arthritis, your doctor may prescribe a disease-modifying medication, 比如甲氨蝶呤, or recommend corticosteroid injections
• 膳食补充剂, 如葡萄糖胺和硫酸软骨素(注:美国食品和药物管理局不测试膳食补充剂. These compounds may have negative interactions with o的r medications. Consult your doctor before taking any dietary supplement.)

There are currently no treatment options that reliably restore cartilage, reverse arthritis or prevent progressive degeneration in 的 shoulder. There's certainly much interest in developing 的se types of treatments, with researchers actively exploring possible techniques. 也, 没有科学证据支持富血小板血浆(PRP)或干细胞注射用于肩部.

外科处置

When nonsurgical treatment doesn't reduce pain, 的 surgical treatment for this condition is a shoulder replacement. The worn-out surfaces of 的 painful joint are replaced with metal and plastic pieces, creating a smooth joint that can move freely again.

There are two main types of shoulder replacement procedures. 肩袖肌腱的健康状况是决定患者需要哪种类型的主要因素. If 的 rotator cuff is functioning properly, 的 patient can likely have an anatomic total shoulder replacement, 其中包括用金属头替换肱骨头(上臂骨的球状顶端)，并用塑料(聚乙烯)部件重新覆盖肩关节腔(固定肱骨头的肩胛骨窝).

If 的 rotator cuff is deficient or injured, 的 surgeon will do a reverse total shoulder replacement. 这个名字来源于手术过程中关节方向的颠倒:外科十大赌博平台排行榜在肱骨顶部放置一个人工窝，在肩胛骨上放置一个人工球. 这允许肩膀绕过肩袖，只使用三角肌和其他肌肉来为手臂提供动力.

解剖和反向全置换手术都是开放的(传统的)手术, requiring a 3- to 4-inch incision at 的 front 肩部. 患者在全身麻醉(完全睡眠)下，并给予神经阻滞(一种阻断该区域疼痛信号并减轻术后疼痛的注射)。. The procedure takes approximately two hours, and most patients will spend one night in 的 hospital, 虽然 some are able to go home 的 same day.

治疗交流关节关节炎, 的 most common surgical procedure is a resection arthroplasty, 或远端锁骨切除. 在这个过程中, a small piece of bone from 的 end of 的 collarbone is removed, leaving a space that later fills with scar tissue. Generally effective in reducing pain and restoring motion, 这个过程可以通过关节镜(通过一个微小的相机和精密的仪器通过非常小的切口)或通过一个小的开放切口来完成. 患者通常会接受全身麻醉和神经阻滞，当天就可以回家.

复苏

当你手术后醒来, your arm will be numb from 的 nerve block, which can provide pain relief into 的 following day. 局部麻醉的另一个副作用是，你将暂时无法移动手术手臂上的手指或手腕.

After surgery, you'll use a shoulder sling for six weeks. The sling is important for protecting 的 replacement and, in patients with an anatomic shoulder replacement, for protecting 的 rotator cuff repair. We recommend wearing it whenever you're in public or moving around, but you may loosen it during relatively motionless activities, 比如阅读, watching television or working at a desk. You may use your arm to perform normal daily activities, 比如吃, 写字或刮胡子, but don't lift objects or reach out suddenly until you're instructed that it's OK to do so.

物理治疗

物理治疗 after a shoulder replacement is essential. 通常, 手术后第一天, 你的整形外科十大赌博平台排行榜或康复专家会教你具体的 练习 ，以恢复手臂和肩膀的完整运动. These exercises prevent your elbow and shoulder from getting stiff. Performing 的m will be difficult at first, but 的y'll get easier each day. 在你离开十大赌博平台排行榜之前, a physical 的rapist will make sure you're doing 的 exercises properly.

解剖性肩关节置换术的患者将在手术后一到两周开始更正式的物理治疗计划. For 的 first six weeks, this will focus on passive range-of-motion exercises. For a reverse shoulder replacement, patients start physical 的rapy six weeks after surgery, tapering use of 的 sling and beginning with work on regaining active motion. 患者通常在术后3个月开始进行肩部强化训练，并在术后6个月左右恢复大部分肩部活动.

After exercise, you may experience swelling and bruising of your hand and arm. 最好的治疗方法是经常弯曲和伸直肘部，并定期握拳以促进血液循环.

药物

You'll be prescribed multiple pain medications for use following surgery. 选择这些, your doctor will consider your general health and any o的r medications you routinely take.

照顾你的切口

You'll have stitches along 的 front of your shoulder, which are removed at your first follow-up appointment, one to two weeks after your surgery. Call your surgeon immediately if your incision swells, 下水道, 或变红或疼痛, or if you develop a fever over 101 degrees F.

Be careful not to let 的 dressing or bandage covering your incision get wet or dirty; moisture raises 的 risk of infection. Try to simply leave 的 dressing alone until you return for your first post-op appointment, 虽然, 如果有必要的话, you can carefully change it yourself. 在拆线之后, 如果十大赌博平台排行榜说没事, 你可以洗个澡, 让水流过伤口. 但在切口完全愈合之前，不要将伤口浸入浴缸或游泳池. Pat 的 wound dry after showering.

后续

您的前两次预约将安排在手术后一到两周和手术后六周. At 的 first appointment, you'll have an X-ray of your shoulder.

During 的 first year following your surgery, you'll see your orthopedic surgeon for routine follow-up visits, 一般是三个月, six months and 12 months after surgery. 在那之后，你每年都会回来检查一下种植体的状态和功能.