The Clinic And Anatomy Observation On Tenderness Points Of Soft Tissue Of Shoulder Region

1. Objective:1.1 To provide the distribution law and clinical features of tenderness points on shoulder region for the diagnosis and treatment of the shoulder pain.1.2 To provide the anatomic data for clinical location, manipulative operation, and trigger point injective treatment, etc.2. Methods:2.1 Clinical research: 54 cases of patients who were suffering from the shoulder pain were screened. The location of pain, characteristics, duration, symptoms of referred pain, visual analogue scale(VAS) and simultaneous phenomenon were made clear.2.2 Anatomic observation: 6 pieces of cadavers were chosed and measured to show the morphological structure, adjoining relationship, the courses and distribution of nerve and blood vessel.3. Results:3.1 Clinical research: Shoulder pain was quite common. The characters of symptoms were different. The Symptom include pain, limitation of activity and tenderness. Sometimes the pain could radiate to scapular region, cervical part and hand. The most painful points were found in upper trapezius, infraspinatus, coracoid process, lesser tuberosity of humerus and subacromion et al, moving with humerus. In the 176 patents of shoulder pain, 52 cases were infraspinatus inflammation, 50 cases were upper trapezius inflammation, 24 cases were freeze shoulder, 12 cases were rotator cuff tears, 10 cases were levator scapulae inflammation, 6 cases were coarcoiditis, 5 cases were subacromial bursitis, 4 cases were acromioclavicular joint inflammation, 2 cases were scalenus posterior inflammation and 1 case was supraspinatus inflammation.3.2 Anatomic research: The upper surface of the coracoid process gived attachment to the pectoralis minor. Its under surface gived attachment to the pectoralis minor. Its medial and lateral borders gived attachment to the coracoacromial ligament. The apex was embraced by the conjoined tendon of origin of the coracobrachialis and short head of the biceps brachii and gived attachment to the coracoclavicular fascia. On the medial part of the root of the coracoid process was a rough impression for the attachment of the conoid ligament. And running from it obliquely forward and lateralward, on to the upper surface of the horizontal portion, was an elevated ridge for the attachment of the trapezoid ligament. The width of the intertubercular groove in left was wider than the right side. The depth was opposite. The height of the lesser tubercle in the right side was higher than the left side. The infraspinatus was triangle and flat, which covered the infraspinatous fossa.4. Conclusions:4.1 Myofacial pain was quite a common reason of the shoulder pain. The main objective sign was a local tenderness point. It was often diagnosed by the obvious tenderness point. Tenderness points of freeze shoulder and rotator cuff tears were more and were differernt from each other. The characteristic of tenderness point often changed on the different stage of one disease. 4.2 The tenderness points and their characteristic were different as the reasons of shoulder pain were too many. The tenderness point of coracoid process could be found on the patients of freeze shoulder and coarcoiditis. The tenderness points of rotator cuff tears could be easily found in scapular region and the region between coracoid process and lesser tuberosity of humerus and be hard found in upper trapezius et al, of which is different from freeze shoulder.4.3 Shoulder joint was complicated, including bones, muscle, tendon, ligament, bursa mucosa and articular. Also, appropriate attention should be given to needling to avoid causing injury. Besides, in committing local injection, the depth of needing, accompanied with a moderate amount of medicine was important.