fa درد شانه: تجربه دو ساله در گروه جراحی شانه بیمارستان شهدای هفتم تیر ارتوپدی Orthopedic پژوهشي Research <p>  در این مطالعه پرونده 82 نفر از بیمارانی که به درمانگاه شانه بیمارستان شهدای هفتم تیر مراجعه کرده بودند به طور گذشته نگر مورد بررسی قرار گرفت. 42 مورد از این بیماران مرد و 40 مورد زن بودند. سن مردان مبتلا 25-75 و سن زنان مبتلا 25-65 سال بود. میانگین سنی مردان 19/49 و میانگین سنی زنان 97/45 سال بود. میزان ابتلای شانه راست بیشتر از شانه چپ بود. بیماران بیشتر در فصل بهار و تابستان مراجعه می کردند ولی سرما را در تشدید درد دخیل می دانستند. بیماران در توجیه درد علت مشخصی را ذکر نمی کردند ولی در سابقه آنان زمین خوردن، ضربه مستقیم و غیر مستقیم در اثر تصادفات، دیابت، مسائل شغلی و ... وجود داشت. در مطالعه حاضر شایعترین علت درد شانه التهاب آبکیس (Bursa) زیر آخرمی (subacromial) بود. از 82 بیمار ، 46 مورد 56% با درمان صحیح طبی یعنی مصرف داروهای ضد التهاب غیر استروئیدی (NSAIDAs) فیزیوتراپی بر طبق دستورالعمل دکتر نیز (Neer) و در بعضی از موارد، بخصوص در افراد بالای 40 سال، تزریق ترکیبات کورتیکواستروئیدی در زیر اخرم (acromion) بهبود یافتند. 14 مورد 18% از بیمارانی که به درمان طبی جواب ندادند، حاضر به ادامه معالجه نشدند. 22 مورد باقی مانده 26% بستری شده، تحت عمل جراحی قرار گرفتند. از این تعداد، 11 مورد زن و 11 مورد مرد بودند و قبل از عمل برای همه آنها درمان طبی انجام شده بود. در تمام بیماران معاینه بدنی کامل، آزمایشهای مختلف و پرتونگاری (radiography) از شانه در سه جهت انجام شد. مفصل انگاری (arthrography) تصویربرداری با تشدید مغناطیسی (MRI) برش نگاری رایانه ای (CT) و فراصوت نگاری (ultrasonography) هم بر حسب مورد در این بیماران انجام شده بود. از 22 مورد فوق 5 نفر ( 3 مورد زن و 2 مورد مرد) قبل ازعمل، جهت تشخیص قطعی، تحت مفصل بینی (arthroscopy) تشخیصی قرار گرفتند و در دو مورد هم لابروم (labrum) پاره به وسیله مفصل بین (arthoroscope) برداشته شد. نتایج اعمال جراحی در 80% خوب و عالی بود. در نتیجه می توان گفت که در صورت عدم پاسخ به درمان طبی، درمان جراحی روش مثبتی می باشد. </p> <div style="mso-element: frame mso-element-frame-width: 516.2pt mso-element-frame-height: 4.65in mso-element-wrap: auto mso-element-anchor-horizontal: margin mso-element-left: .05pt mso-element-top: 23.35pt"><table cellspacing="0" cellpadding="0" width="688" height="446" vspace="0" hspace="0"><tbody><tr><td style="BORDER-BOTTOM: #f0f0f0 BORDER-LEFT: #f0f0f0 PADDING-BOTTOM: 0in BACKGROUND-COLOR: transparent PADDING-LEFT: 0in PADDING-RIGHT: 0in BORDER-TOP: #f0f0f0 BORDER-RIGHT: #f0f0f0 PADDING-TOP: 0in" height="446" valign="top" align="left"><p style="LINE-HEIGHT: 19.9pt TEXT-INDENT: 16.3pt MARGIN: 0in 0in 0pt 0.2pt mso-element: frame mso-element-frame-width: 516.2pt mso-element-frame-height: 4.65in mso-element-wrap: auto mso-element-anchor-horizontal: margin mso-element-left: .05pt mso-element-top: 23.35pt mso-line-height-rule: exactly" class="Style"><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">In this retrospective study, </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">82 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">patients who admitted </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt">to </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">shoulder surgery clinic of shohada-ye 7th Tit Hospital from March </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">1995 </span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt">to </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">March </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">1997 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">were analyzed. Of these patients, </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">42 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">were male and </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">40 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">were female. The ages of male patients ranged from </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">25 </span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt">to <span style="mso-font-width: 106%"><font size="2" face="Times New Roman">75 </font></span></span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">years and of female patients from </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">25 </span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt">to <span style="mso-font-width: 106%"><font size="2" face="Times New Roman">65 </font></span></span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">years. The mean age of males was </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">49.19 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">and females was </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">45.97 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">years. Right shoulder was affected in the majority of patients. Referrals were more in spring and summer, but patients believed that cold can aggravate pain. The etiology was unknown but they have mentioned history of trauma, car accident, diabetes, occupational problems and .... In present study, subacromial bursitis </span></i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 9.5pt">was </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">the most common cause of shoulder pain. of </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">82 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">patients, </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">46 (56%) </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">were improved by proper medica) ther,apye i.e. administration of nonsteroidal anti-inflammatory drugs, physiotherapy based on Neer's protocol ana in some cases, especially in those older than </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 9.5pt mso-font-width: 111%">40 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">years, subacromial corticosteroid injection. 14 cases </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">(18%) </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">who did not respond </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt">to </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">medical therapy, refused </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt">to </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">be followed up. </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">22 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">cases </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">(26%) </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">underwent surgical therapy. Of these latter </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 11pt">cases, </span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">11 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">were male and </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">11 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">were female and all had received medical therapy before operation. Complete physical examination, different laboratory tests and radiography </span></i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">- <i>three views </i>- <i>were performed for all cases. Arthrography, MRI, CT scanning and ultrasonography were performed depending on the case. Of these </i></span><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">22 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">cases, </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">5 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">cases </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">(3 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">females and </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10pt mso-font-width: 106%">2 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">males) underwentpreoperative diagnostic arthroscopy for definite diagnosis. Torn labrums were removed by arthroscope in </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10.5pt mso-font-width: 114%">2 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">of these latter </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10.5pt mso-font-width: 114%">5 </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">cases. The results of surgical operations were good and excellent in 80% of cases. So, it can be concluded that surgical operation is </span></i><span style="FONT-FAMILY: "Times New Roman","serif" FONT-SIZE: 10.5pt mso-font-width: 110%">a </span><i><span style="FONT-FAMILY: "Arial","sans-serif" FONT-SIZE: 10pt">good approach for those patients who are not responsive to medical therapy. <p></p></span></i></p></td></tr></tbody></table></div> درد شانه، نشانگان برخورد (Impingement Syndrome) در شانه، شانه چرخان (Rotator Cuff)، مفصل بینی (Arthroscopy)، تزریق در زیر اخرم (Subacromial injection) Shoulder Pain, Shoulder impingement Syndrome, Rotator, Arthroscopy, Subacromial Injection 281 289 http://rjms.iums.ac.ir/browse.php?a_code=A-10-1-1103&slc_lang=fa&sid=1 Ali Akbar Khorsandi علی اکبر خورسندی 3900319475328460021988 3900319475328460021988 Yes