臨床上，肩痛有一個常見的診斷:impingement syndrome，常常是靭帶發炎和關節囊發炎的合併問題。
肩部的問題很常合併發生，也就是禍不單行，在肩部有如此多構造，卻存在小小的空間中，，所以我們必須很小心地舉手(投足)，否則受傷的機會，真的太大了。----> 如何治癒呢?
身體一切的疼痛問題，若是落入惡性循環中，疼痛真的是一個接著一個來。
'impingement syndrome.' Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons. There is a difference between tendonitis and bursitis, but in most cases of impingement syndrome there is a combination of these problems.
Impingement syndrome，由上圖可知，疼痛多在肩部的外側，和上臂三角肌(outer deltoid)外側位置。若是疼痛超過deltoid的位置，則必須要作更謹慎的評估。病人肩部的主動動作會受影響。
另外幾段話，大家一起來思考常見的問題 Rotator cuff tendinitis 肩旋轉肌發炎 :
The cause of rotator cuff tears is likely multifactorial. Degeneration, impingement, and overload may all contribute in varying degrees to the development of rotator cuff tears.
---> 原因是多重的，可能是內在或外在因素。
Subsequent investigations in throwing athletes suggest that tension overload contributes to these injuries [5,6]. Tension overload is thought to occur when the ability of the rotator cuff to compress and maintain the stability of the glenohumeral joint is overwhelmed by the distractive forces of throwing or trama. In other words, rotator cuff muscle weakness allows subluxation of the glenohumeral joint, leading to impingement, which contributes to the development of rotator cuff tears.
-----> 肩旋轉肌的力量不足，引發肩關節脫位，再導致肩旋轉肌發炎或斷裂。所以若導因是肩旋轉肌力量不足，但治療上僅作物理儀器治療或是開刀治療的話，結果是…
This classic description may be inaccurate. Several observational studies suggest that pain associated with rotator cuff tears, when present, is nonspecific and may be due to associated subacromial bursitis, not the tear itself [9,10]. Other observational studies suggest a large portion of rotator cuff tears are asymptomatic [10-13]. Although some degeneration of the rotator cuff may be inevitable in most individuals beyond the fifth decade of life, these degenerative changes do not necessarily cause significant functional impairment.
----->一大部分的肩旋轉肌tear的病人是沒有症狀的，也就是沒有明顯功能上的受限。當有一天，MRI( 核磁照影)檢查有肩旋轉肌tear的病人，也不必太驚奇。是否需要開刀?就讓醫師專業的再評估。
