什麼是五十肩?怎麼知道以及怎麼治療? (by 姚斯元物理治療師)
肩膀系列文章第二篇提到常見的肩膀問題有:肩夾擠症候群、五十肩 (冰凍肩)、旋轉肌撕裂傷。今天要來細談五十肩 (冰凍肩),聊聊五十肩的症狀、怎麼簡單自我檢測、如何就醫與治療?
五十肩 (冰凍肩) 的症狀
五十肩的原因是肩關節囊裡面沾黏住了,原本要能滑來滑去、轉來轉去的關節,現在像是被膠水黏住一樣、卡住、發炎。比較容易得到五十肩的有糖尿病、甲狀腺、心血管問題、結核、巴金森式症等問題的人。
先讓我們釐清一件很重要的事:五十肩 (冰凍肩) 會讓你肩膀活動受限,但是肩膀活動受限不代表你就是五十肩!天底下有一大堆原因可以讓你肩膀受限,例如常見的肩夾擠症候群就是其中一個。
五十肩常見的症狀有:
- 睡覺壓到肩膀會痛
- 睡覺時因為肩膀太久沒動會疼痛,甚至痛醒
- 天氣冷的時候肩膀會比較不舒服
- 穿脫 T 恤之類需要大角度活動肩膀的動作時會很痛
- 如果你是女性的話,穿脫內衣這個動作時,肩膀活動會有困難
- 手抬不起來,向前向上舉無法180度貼在耳朵上
你怎麼知道那是五十肩還是其他問題?
判斷五十肩(冰凍肩)的方法有很多,臨床上常見的方法之一就是看關節囊的受限模式 (Capsule Pattern)。關節囊受限模式是根據歸納出來的結果,意思是假如你肩關節活動角度卡住是因為關節囊裡面的原因造成的,那通常卡住最多的角度會是外轉、接下來是外展,之後是內轉(外轉的反方向)。
如果卡住的程度不是依照這個嚴重順序的話,我們可以合理懷疑你的肩膀痛、肩膀活動卡住有其他原因。一個比五十肩更常見的肩膀活動受限原因是肩夾擠症候群,脊上肌被夾到、受傷、發炎,久了之後可能導致萎縮,然後造成肩膀活動受限。
我們會叫病人實際做外轉,外展,內轉的動作並且測量他們的角度。然後跟正常的角度去相比 (外轉:90度,外展180度,內轉:90度),看受限的比例有沒有依照關節囊受限模式。
內轉+外轉測試 (鏡頭有點晃):
外展測試 (有點長,自己快轉看重點就好):
五十肩 (冰凍肩) 的治療
其實五十肩並不難治療,但是他很花時間。其中一個常見的方法是關節鬆動術,顧名思義就是用徒手的方法拉開你的關節囊,增加活動度。小小的缺點是這樣的治療方式會有些疼痛。
關節鬆動術影片,警告!內有胸肌小鮮肉 ♥︎:
花時間的地方在於,五十肩要完全治療通常會需要 6~12 個月,你的關節活動角度才會恢復到正常角度。
另外有時候五十肩也會使用一些注射治療來搭配徒手治療一起 Combo 一下。
五十肩(冰凍肩)的疾病進程
根據文獻,五十肩的疾病進程可分為三個階段,每個階段約6個月:
- 第一階段:主要症狀是疼痛,很容易被診斷成其他問題,例如肩峰下滑囊被夾之類的。但是第一階段快結束時,活動角度受限的問題開始浮出,變得比較好診斷。
- 第二階段:疼痛減緩,主要的會變成活動角度卡住。
- 第三階段:冰凍肩逐漸解凍,活動角度慢慢變大。
那我可以自己拉開關節來治療自己的五十肩嗎?
確實是有病人靠著自己死命拉關節的方法治療好自己的案例,但是DIY有以下風險:
- 比起物理治療師幫你做關節鬆動術,自己拉扯關節,對關節的壓力是比較大的。
- 如果你不當施力拉過頭,可能會造成關節發炎、甚至肌肉拉傷。
- 假如你沒有給醫生、物理治療師診斷、評估過,就自己判斷是五十肩,就自己亂拉,那可能完全沒效,甚至越弄越慘。
提醒大家,五十肩雖然很有名,但是其實真正五十肩的人只佔人口2~5%左右,並不如他的名氣一般常見。所以提醒大家真的不要隨便 DIY,有肩膀問題還是要找醫生與物理治療師。
延伸閱讀:
合作撰寫:

好痛痛復健科、骨科、物理治療、運動訓練搜尋器
註:本部落格文章是以科普、衛教為出發點,不代表任何人的生理狀況。每個人的身體皆不相同,有任何疑問請詢問自己的醫師、物理治療師、專業教練。
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