어깨 통증 category별 치료 전략

어깨통증 환자는 아래의 진단 방법에 따라 아래의 3개의 category로 구분할 수 있다.

각 category 별로 최적의 치료방법을 제시할 수 있다

진단방법)

이학적검사 : 수동검사(굴곡, 외회전, 뇌전, 내회전)

저항검사

초음파검사

방사선검사 : SSP outlet view

구분)

categoty 1  회전근개파열, 충돌증후군, 와순파열, 견갑골이상운동증

1차 치료 목표 : 통증조절

지침) 수동적 관절가동범위 검사를 시행하여 외회전과 외전을 비교한다.

외회전 시 외전보다 통증이 심하거나 가동범위위 제한이 심하면

관절간내 주사를 시행하고 외전시 통증이 더 심하거나  제한이 심하면

점액낭내 주사를 시행한다.

2차 치료 목표 : 회전근개의 기능개선

1) 중부 승모건과 하부승모건 강화운동을 시행하여 견갑골을 안정화시키고

신장성 극상건과 극하건 강화운도을 시행하여 회전근개 기능을 회복

시킨다.

2) 충격파치료 또는 증식치료를 시행한다

categoty 2  오십견, 활액막염, 외상성관절절염, CRPS, 관절 강직(원인불문)

1차 치료 목표 : 통증 조절

관절강내 주사를 시행하여 통증을 감소시킨다.

초진 시, 초진 1주 후, 초진 3주 후 3회 주사를 시행한다.

1회 주사 후 증상이 없어도 3회 시행한다.

2차 치료 목표 : 관절가동범위 회복

어깨 관절 굴곡, 내회전, 외회전 운도을 지속적을 시행하여

외회전이 60도 이상이 되어야 재발을 안한다.

수압팽창술

category 3.  석회화성건초염

1차 치료 목표 : 통증 조절

석회를 주사바늘로 자극 후 점액낭낭내 주사를 시행한다.

또는 석회 흡인 시도 후 점액낭내 주사를 시행한다.

2차 치료 목표 : 석회화 흡수

체외충격파 치료

수술 권고(적응증)

1) 외상에 의한 급성기 파열 : 4개월 이내에 수술을 시행한다.

2) 65세 이하에서, 증상이 있는 전층 파열

3) 최근 기능장애를 동반한 파열

4) coraco-humeral ligament 석회화를 동반한 전층파열(?); 경험적인 소견

부분파열이나 증상이 심하지 않은 전층파열 환자에서 예방적인 목표로 수술을

권고하지 않는다.

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