推拿考试Word格式.docx

推拿考试Word格式.docx

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5.凤凰展翅

6.天门入虎口

7.运水入土与运土入水

8.飞经走气

9.猿猴摘果

10.开玄机（璇玑）

11.揉脐摩腹与揉龟尾推七节

12.打马过天河

v小儿桡骨头半脱位subluxationofradiushead

•“牵拉肘”pulledelbow，俗称“肘错环”、“肘脱环”。

1～3岁发病率最高。

•发病机制：

5歲以下的儿童橈骨頭和頸部的直徑幾乎相等，環狀韌帶松馳.在肘部被牽拉時，有部分環狀韌帶被夾在肱橈關節的間隙中所致。

Thediameteroftheradialheadandneckofchildrenbelow5yearsoldarealmostequalandtheannularligamentisrelaxed.Partofannularligamentwillstuckinthebrachioradialisjointgapwhentheshoulderisbeingpulled.

•小儿肘關節囊前部及環狀韌帶松馳，突然牽拉前臂時，肱橈關節間隙加大，關節內負壓驟增，肘前關節囊及環狀韌帶被吸入關節內而發生嵌頓所致Thefrontpartoftheinfantileelbowcapsuleandtheannularligamentarelooseandrelaxed,whentheforearmisbeingpulledsuddenly,thespaceofbrachioradialisjointandnegativeintra-articularpressureareincreased,elbowjointcapsuleandannularligamentisdrawnintothejointandbeingincarcerated. 

•當肘關節于伸直位牽拉時，橈骨頭從圍繞其周圍的環狀韌帶中向下滑脫，由于肱二頭肌的收縮，將橈骨頭拉向前方，形成典型的橈骨頭向前內方半脫位。

Whentheelbowjointisbeingpullinginextension,radialheadslipdownwardfromitssurroundingannularligament.Duetobicepcontraction,radialheadwillbepullingforwardandformatypicalradialforwardsubluxation.

•Radialheadsubluxationreduction;

first,palmofchild'

shandisgraspedasiftoshakeit;

elbowisencircledwithotherhand,thumboverannularligament;

next,palmofchild'

shandissupinateandthenbendtheelbow.

Clinicalfeatures

•患肢纵向被牵拉损伤史。

Limblongitudinallypullinginjuryhistory

•肘关节半屈曲位，不肯举臂；

前臂旋前，不敢旋后。

Elbowsemiflexion,refuseraisethearm,forearmpronationnormal,noableforearmsupination

•桡骨头处压痛，局部无明显肿胀。

radialheadtendernesswithoutswelling

•X线检查无异常。

X-raynormal

v小儿特有的手法是：

掐法Fingernailpressingmanipulation、arc-pushingmanipulation运法

v小二常用手法

✓推法Pushingmanipulation

✓揉法Kneadingmanipulation

✓按法Pressingmanipulation

✓摩法Rubbingmanipulation

✓掐法Fingernailpressingmanipulation

✓捏法Pinchingmanipulation

✓运法arc-pushingmanipulation

踝关节及肩关节损伤（20M）

（a）踝关节扭挫伤Contusionofsprainofankle（10M）

v踝关节周围主要的韧带:

Ø

内侧副韧带Medialcollateralligament

✓Alsoknownas三角韧带Deltoidligament（起于内踝,是一条坚强的韧带，不易损伤）

外侧副韧带lateralcollateralligament

✓起自外踝,止于距骨前外侧的为距腓前韧带Anteriortalofibularligament（easyinjuredthemost）

✓止于跟骨外侧的为跟腓韧带Calcaneofibularligament

✓止于距骨后外侧距腓后韧带Posteriortalofibularligament

下胫腓韧带inferiortibiofibularligament

✓Alsoknownas胫腓联合韧带TibiofularSyndesmoticligament

✓是保持踝关节稳定的重要韧带。

韧带损伤

vR.I.C.EManagement

Rest

✓Reduceactivityforinjureparttorest

Ice

✓15-20mins.Changesoffeelingoccurwhenapplyingcold:

▪Painslightlynumbnessslightsharppaingraduallostofpainfeeling

Compression

✓Preventswellingfromoccurring

Elevation

✓Elevateinjuredparttoapositionthatslightlyhigherthanheart

v踝扭伤手法治疗

a）Tendonrelaxingmanipulation

b）Tuinamanipulation

c）Immobilization

d）Exercise

e）Medication

v韧带断裂者该如何固定？

a）用石膏管型固定

b）内侧断裂固定于内翻位，外侧断裂固定于外翻位

c）6周后解除固定下地活动。

v韧带撕裂伤该如何固定？

a）用胶布固定，外加绷带包扎。

b）外翻损伤固定于内翻位，内翻损伤固定于外翻位

c）一般可固定2～3周。

（b）肩关节周围炎AdhensiveCapsulitis/Frozenshoulder/ScapulohemeralPeriarhitis（10M）

vDefinition:

Adhesivecapsulitisisacommonconditioncharacterisedbypainintheshoulderjoint,reducedrangeofmotionintheshoulder

vEtiology:

Ð

Commonlycausedbyelderlyqideficiency,tendonlackofnourishmentduetoqiandblooddeficiency,blooddeficiencypain年老气虚，气血不足，血虚生痛

Livinginhumidarea,exogenouswindcolddampness,attackvesselsandmusclecausesbloodstagnation,painfulmusclecramp久居湿地，风寒湿邪致血凝不流

Traumabonesorspraincausesdamagetothemuscle,bloodstagnationblockingthevessel,musclelackofnourishment,painfulcramp外伤

v3stages:

Acutestage:

mainlyshoulderpain,limitedshouldermotion.Courseofdiseasearound1–3months

Frozenstage:

severelimitedmotionoftheshoulder,obviousaggravatedpain.Courseofdiseasearound2-3months

Recoverystage:

orhealingprocessaftertreatment，aggravatedpain,thegradualrecoveryofthefunctionalactivity

肩臂放射痛肩部压痛颈部压痛肩关节活动

颈椎病有无有良好

肩周炎无有无差

vSign

✓Senseofheavinessattheshoulder

✓Slightpain

✓Limitedmotionoftheshoulder

vPhysicalExamination

✓Nosignofrednessswollen

✓Limitedrangeofabduction

✓Shouldermuscleatrophy（obviouseffectondeltoidmuscle）

vDiagnosis

oSorenessandpainattheshoulderattheinitialstage,slowlyintegratedintocontinuouspain

oUsuallyworsenatnight

oShouldermovementdisorders,unabletodoactivitiessuchascombing,takingoffclothes

oDayslater,occursdifferentlevelofmuscleatrophyaroundshoulderregion,bulgingacromian,upperarminconvenienttolifeup,inconvenientbackwardextension

vExamination

Antiflexion

backwardextension

abduction（maximum90degrees）

externalrotation（maximum90degrees）

medialrotation

vSupraspinatustendinitis冈上肌腱炎

肩袖肌肉rotatorcuffmuscle：

冈上肌supraspinatusmuscle

冈下肌infraspinatusmuscle

肩胛下肌subscapularismuscle

小圆肌teresminormuscle

Characteristics:

Gradualpainattheshoulder

Abductionat60~120degree,severepainpresent.

Abletodoup-raisingmotionpassively（differentiatedfromFrozenshoulder）

Tendernessatgreatertuberosityorbackoftheshoulder

X-raycanseelocalizedcalcification

Manipulation

Tendonregulatingmethod（acutestagesoft,chronicstagemorestrength）

Medication（topical,fumigation,orally）

Wateraccupuncturetherapy（chronic）

Regularexercise（acute）

Etiology

肩部伤筋

中年退变

慢性劳损

vLongheadofbicepstendinits（frontshoulderpain）

Signs:

Limitedmotionofshoulderjoint

Painfulduringactivity（abductionofupperlimb）

Obvioustenderpointatintertubercularsulcus

Diagnosis:

Anti-resistancetest

Shoulderinternalrotationtest

vShortheadofbicepstendonitis

Coracoidspain,tenderness,swollen,limitedmotion

Handthumbpressingcoracoidsregion（+ve）

Antiresistancetest

Whatisdugassyndrome

humeralheadispalpableatthearmpitareaorpalpableanteriorhumeralhead

Doingshoulderjointadduction,handfailstoputontheothersideoftheshoulder,orfailstoputonthechest

Normaljointfunction

颈与腰疾病20M

（a）Stiffneck

oAlsoknownasTorticollis（失枕）

oDefinition:

--Characterizedbysorenessanddifficultymovingtheneckespeciallywhentryingtoturnthe

headtotheside

--pain,sorenessordiscomfortintheneckwhichnoticeablewithneckmovement

oinvolvemuscle:

▪Sternocleidomastoid胸锁乳突肌

▪Trapezius斜方肌

▪LevatorScapulae肩胛提肌

oTuinamanipulation

▪Continuously

▪Softly

▪Evenly

▪Forcefully

oWhatistheclinicalmanifestationofstiffneck?

▪Restrictedcervicalmovement,

▪deviationoftheheadtotheaffectedside

▪Aggravationinmovement.

oCheck3linesoftheneckwhichinclude:

▪颈正中线Centerlineofneck

▪左颈旁线Leftlineofneck

▪右颈旁线Rightlineofneck

oTherapeuticprinciple

▪Smoothmeridiantoactivateblood

▪Warmmeridiantodredgecollaterals

oCauses:

▪Sleepingposition

▪Improperheightorhardnessofpillow

▪Poorposture

▪Invasionofcoldwindintocervicalregion

oMosteffectivewaystorelievepain:

--点按法（Point-PressingManipulation）:

膀胱经、督脉在颈部的走行

方向，用双手拇指指腹进行点按

--pressingandkneadingmanipulation

--graspingmanipulation

oWhatisthegeneralmanipulationforstiffneck?

a）Checkingmanipulation检查手法

b）Tendon-relaxingmanipulation放松手法

c）Rotating-pullingmanipulation旋转扳法

oClusternodule筋结:

formedwhenthemuscleistootense;

itisnormallyinalumporline-stripshapedwhenpalpate.条状或块状

（b）颈椎病Cervicalspondylopathy

CervicalSpineSyndromeisanage-relateddegeneration（‘wearandtear’）ofthevertebraeanddiscsintheneckwhichmayaffectspinalnerveroots,spinalcord,sympatheticnervesandvertebralarteriesresultinginaseriesofsymptoms.

vAnatomicalofspine

ConsistofAtlas（C1）,Axis（C2）,Luschka（C3-C6）

LuschkaJoint

smallsynovialjointsformedsecondarilybetweenthelaterallips（uncinateprocesses）ofthesuperiorsurfacesofthebodiesofthelowercervicalvertebraeandtheinferiorsurfaceofthesuperiorvertebralbody.Allowforflexionandextension

✓Limitlateralflexioninthecervicalspine.

✓Allowbettermovementofcervicalspine&

Stabilizecervicalspine

Disorders:

✓neckpainorinvolvedshoulderpain.

✓neckmovementdisorder,especiallyrotationdysfunction,alittlerotationthatneckpain.

Relationofanatomywiththedisease

a）头部的旋转运动

b）骨赘的影响

c）椎动脉变异

d）血管病变

e）损伤和劳损

f）椎动脉解剖特性-

vGeneralsymptoms

Painintheneck.

Headachesfromtimetotime.

Numbness,pinsandneedlesorweaknessmayoccurinpartofthearmorhand. 

vTypesofCervicalSpondylopathy

Cervicaltype颈型

Cervicalradiculopathy神经根型

Cervicalmyelopathy脊髓型

Vertebralarterytype椎动脉型

Sympathetictype交感神经型

Mixedtype混合型

1.Cervicaltype颈型

ReducedR.O.Mofcervical

Stiffneck, 

particularlyafteran