V\u1ecb tr\u00ed th\u01b0\u1eddng hay g\u1eb7p trong t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n l\u00e0 ph\u1ee9c h\u1ee3p s\u1ee5n vi\u1ec1n bao kh\u1edbp tr\u01b0\u1edbc d\u01b0\u1edbi \u1ed5 ch\u1ea3o (84 \u2013 97%) (c\u00f2n g\u1ecdi l\u00e0 t\u1ed5n th\u01b0\u01a1ng Bankart hay Perthes). M\u1ea5t v\u1eefng vai sau chi\u1ebfm 5%. T\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n \u0111a h\u01b0\u1edbng \u0111\u01b0\u1ee3c Neer v\u00e0 Foster m\u00f4 t\u1ea3 n\u0103m 1980, g\u1ed3m m\u1ea5t v\u1eefng tr\u01b0\u1edbc, sau v\u00e0 d\u01b0\u1edbi.<\/p>\n
V\u1ec1 ph\u01b0\u01a1ng di\u1ec7n l\u1ecbch s\u1eed, \u0111i\u1ec1u tr\u1ecb m\u1ea5t v\u1eefng kh\u1edbp vai trong qu\u00e1 kh\u1ee9 th\u01b0\u1eddng t\u1eadp trung v\u00e0o vi\u1ec7c h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp, kh\u00e2u ph\u1ee5c h\u1ed3i v\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu s\u1ee5n vi\u1ec1n b\u1ecb r\u00e1ch th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. C\u00e1c v\u00ed d\u1ee5, \u0111i\u1ec3n h\u00ecnh nh\u1ea5t v\u1ec1 c\u00e1c k\u1ef9 thu\u1eadt t\u00e1i t\u1ea1o n\u00e0y bao g\u1ed3m chuy\u1ec3n c\u01a1 d\u01b0\u1edbi vai (Magnuson-Stack), kh\u00e2u ch\u00e9o \u00e1o c\u01a1 d\u01b0\u1edbi vai v\u00e0 bao kh\u1edbp (Putti-Platt) v\u00e0 chuy\u1ec3n m\u1ecfm qu\u1ea1 v\u00e0 g\u00e2n ph\u1ed1i h\u1ee3p (Bristow-Latarjet). Khi c\u00e1c b\u00e1c s\u0129 ph\u1eabu thu\u1eadt \u0111\u00e3 hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng c\u1ee7a vai, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb m\u1ea5t v\u1eefng kh\u1edbp vai \u0111\u00e3 d\u1ef1a v\u00e0o vi\u1ec7c ph\u1ee5c h\u1ed3i gi\u1ea3i ph\u1eabu.<\/p>\n
GI\u1ea2I PH\u1eaaU<\/h3>\n
Gi\u1ea3i ph\u1eabu ch\u1ee9c n\u0103ng<\/strong><\/p>\n Kh\u1edbp vai \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c k\u1ebft n\u1ed1i v\u1edbi c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c trong c\u01a1 th\u1ec3 nh\u01b0 vai, c\u00e1nh tay nh\u1eb1m h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh v\u1eadn \u0111\u1ed9ng, di chuy\u1ec3n c\u1ee7a con ng\u01b0\u1eddi.<\/p>\n Kh\u1edbp vai l\u00e0 m\u1ed9t kh\u1edbp ho\u1ea1t d\u1ecbch \u0111a tr\u1ee5c. Kh\u1edbp vai \u0111\u01b0\u1ee3c c\u1ea5u t\u1ea1o g\u1ed3m ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay d\u1ea1ng b\u00e1n c\u1ea7u v\u00e0 \u1ed5 ch\u1ea3o x\u01b0\u01a1ng b\u1ea3 vai. Ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay n\u1eb1m trong m\u1ed9t \u1ed5 kh\u1edbp n\u00f4ng \u1edf x\u01b0\u01a1ng b\u1ea3 vai \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u1ed5 ch\u1ea3o. Ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay th\u01b0\u1eddng l\u1edbn h\u01a1n nhi\u1ec1u so v\u1edbi \u1ed5 ch\u1ea3o v\u00e0 m\u1ed9t v\u00e0nh m\u00f4 s\u1ee5n s\u1ee3i m\u1ec1m d\u00e0y kho\u1ea3ng 4 mm \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 s\u1ee5n vi\u1ec1n bao quanh \u1ed5 kh\u1edbp gi\u00fap \u1ed5n \u0111\u1ecbnh kh\u1edbp. V\u00e0nh s\u1ee3i n\u00e0y l\u00e0m s\u00e2u \u1ed5 kh\u1edbp l\u00ean \u0111\u1ebfn 50% \u0111\u1ec3 ph\u1ea7n ch\u1ecfm x\u01b0\u01a1ng c\u00e1nh tay v\u1eeba v\u1eb7n h\u01a1n, trong \u0111\u00f3 chi\u1ec1u s\u00e2u tr\u00ean d\u01b0\u1edbi (9 mm) s\u00e2u h\u01a1n chi\u1ec1u s\u00e2u tr\u01b0\u1edbc sau (5 mm). Saha \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng vi\u1ec7c c\u00f3 th\u00eam s\u1ee5n vi\u1ec1n \u1ed5 ch\u1ea3o l\u00e0m t\u0103ng b\u1ec1 m\u1eb7t ti\u1ebfp x\u00fac c\u1ee7a kh\u1edbp \u1ed5 ch\u1ea3o v\u1edbi ch\u1ecfm c\u00e1nh tay l\u00ean 75% theo chi\u1ec1u d\u1ecdc v\u00e0 57% theo chi\u1ec1u ngang. Karzel v\u00e0 c\u1ed9ng s\u1ef1, trong th\u1eed nghi\u1ec7m c\u01a1 sinh h\u1ecdc \u0111\u1ed1i v\u1edbi c\u00e1c m\u1eabu vai c\u1ee7a t\u1eed thi, \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng s\u1ee5n vi\u1ec1n \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 ph\u00e2n b\u1ed1 c\u1ee7a di\u1ec7n ti\u1ebfp x\u00fac khi m\u1ed9t t\u1ea3i tr\u1ecdng n\u00e9n \u0111\u01b0\u1ee3c t\u00e1c \u0111\u1ed9ng l\u00ean vai \u1edf g\u00f3c d\u1ea1ng 90\u00b0.<\/p>\n Bao kh\u1edbp v\u00e0 d\u00e2y ch\u1eb1ng c\u1ee7a vai, bao g\u1ed3m c\u1ea3 g\u00e2n c\u01a1 nh\u1ecb \u0111\u1ea7u, \u0111\u01b0\u1ee3c g\u1eafn v\u00e0o v\u00e0 tr\u1edf th\u00e0nh m\u1ed9t ph\u1ea7n c\u1ee7a s\u1ee5n vi\u1ec1n, b\u00e1m v\u00e0o \u1ed5 ch\u1ea3o. S\u1ee5n vi\u1ec1n \u1ed5 ch\u1ea3o l\u00e0 ch\u1ed7 b\u00e1m cho m\u1ed9t s\u1ed1 d\u00e2y ch\u1eb1ng nh\u01b0 d\u00e2y ch\u1eb1ng \u1ed5 ch\u1ea3o c\u00e1nh tay tr\u00ean, gi\u1eefa v\u00e0 d\u01b0\u1edbi. R\u00eca ngo\u00e0i v\u00f9ng ph\u00eda tr\u00ean l\u00e0 nguy\u00ean \u1ee7y c\u1ee7a \u0111\u1ea7u d\u00e0i g\u00e2n nh\u1ecb \u0111\u1ea7u, trong khi r\u00eca d\u01b0\u1edbi l\u00e0 nguy\u00ean \u1ee7y m\u1ed9t ph\u1ea7n c\u1ee7a \u0111\u1ea7u d\u00e0i c\u01a1 tam \u0111\u1ea7u. R\u00eca sau v\u00e0 tr\u00ean c\u1ee7a m\u1eb7t ngo\u00e0i s\u1ee5n vi\u1ec1n \u1ed5 ch\u1ea3o cung c\u1ea5p ch\u1ed7 b\u00e1m cho bao kh\u1edbp s\u1ee3i, trong khi m\u1eb7t trong ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi ch\u1ecfm c\u00e1nh tay v\u00e0 ranh gi\u1edbi b\u1edfi m\u00e0ng ho\u1ea1t d\u1ecbch. Ph\u1ea7n tr\u00ean v\u00e0 tr\u01b0\u1edbc tr\u00ean c\u1ee7a s\u1ee5n vi\u1ec1n \u1ed5 ch\u1ea3o b\u00e1m l\u1ecfng l\u1ebbo v\u00e0o g\u1edd \u1ed5 ch\u1ea3o, kh\u00e1c v\u1edbi ph\u1ea7n b\u00e1m d\u01b0\u1edbi.<\/p>\n Gi\u1ea3i ph\u1eabu t\u1ed5n th\u01b0\u01a1ng<\/strong><\/p>\n \u0110\u1ec3 h\u1ed7 tr\u1ee3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n, s\u1ee5n vi\u1ec1n \u0111\u00e3 \u0111\u01b0\u1ee3c chia th\u00e0nh s\u00e1u khu v\u1ef1c: (1) s\u1ee5n vi\u1ec1n tr\u00ean, (2) s\u1ee5n vi\u1ec1n tr\u01b0\u1edbc \u1edf ph\u00eda tr\u00ean r\u00e3nh gi\u1eefa \u1ed5 ch\u1ea3o, (3) s\u1ee5n vi\u1ec1n tr\u01b0\u1edbc \u1edf ph\u00eda d\u01b0\u1edbi r\u00e3nh gi\u1eefa \u1ed5 ch\u1ea3o, (4) s\u1ee5n vi\u1ec1n d\u01b0\u1edbi, (5) s\u1ee5n vi\u1ec1n sau d\u01b0\u1edbi v\u00e0 (6) s\u1ee5n vi\u1ec1n sau tr\u00ean (H\u00ecnh 2). M\u1ed9t s\u1ed1 c\u01a1 ch\u1ebf c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh bao g\u1ed3m l\u1ef1c n\u00e9n, l\u1ef1c nh\u1ed5, l\u1ef1c k\u00e9o, l\u1ef1c x\u00e9 v\u00e0 nh\u1eefng thay \u0111\u1ed5i tho\u00e1i h\u00f3a m\u00e3n t\u00ednh. M\u00f4 h\u00ecnh v\u1ebft r\u00e1ch c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh th\u00f4ng qua h\u00ecnh \u1ea3nh n\u1ed9i soi kh\u1edbp, t\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1ebft r\u00e1ch s\u1ee5n ch\u00eam<\/a> \u1edf g\u1ed1i. C\u00e1c lo\u1ea1i v\u1ebft r\u00e1ch ph\u1ed5 bi\u1ebfn bao g\u1ed3m v\u1ebft r\u00e1ch v\u1ea1t, quai s\u00e1ch, v\u1ebft r\u00e1ch kh\u00f4ng t\u00e1ch r\u1eddi, tho\u00e1i h\u00f3a v\u00e0 t\u1ed5n th\u01b0\u01a1ng SLAP (Superior Labrum from Anterior to Posterior). T\u1ed5n th\u01b0\u01a1ng n\u1eb1m tr\u00ean \u0111\u01b0\u1eddng x\u00edch \u0111\u1ea1o c\u1ee7a \u1ed5 ch\u1ea3o (m\u1ed9t \u0111\u01b0\u1eddng k\u1ebb gi\u1eefa v\u1ecb tr\u00ed 3 gi\u1edd v\u00e0 9 gi\u1edd tr\u00ean \u1ed5 ch\u1ea3o) th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn r\u00e1ch ch\u00f3p xoay<\/a> ho\u1eb7c b\u1ec7nh l\u00fd g\u00e2n nh\u1ecb \u0111\u1ea7u. T\u1ed5n th\u01b0\u01a1ng n\u1eb1m d\u01b0\u1edbi \u0111\u01b0\u1eddng x\u00edch \u0111\u1ea1o, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u00e1ch r\u1eddi, kh\u00f4ng t\u00e1ch r\u1eddi \u1edf ph\u00eda tr\u01b0\u1edbc v\u00e0 ph\u00eda sau, r\u1ea5t c\u00f3 \u00fd ngh\u0129a g\u1ee3i \u00fd cho s\u1ef1 m\u1ea5t v\u1eefng c\u1ee7a vai.<\/p>\n T\u1ed5n th\u01b0\u01a1ng SLAP l\u00e0 t\u1ed5n th\u01b0\u01a1ng r\u00e1ch s\u1ee5n vi\u1ec1n tr\u00ean t\u1eeb tr\u01b0\u1edbc ra sau. X\u1ea3y ra \u1edf nh\u1eefng ng\u01b0\u1eddi n\u00e9m c\u00f3 th\u1ec3 do s\u1ef1 b\u00e1m ch\u1eafc ch\u1eafn ph\u00eda sau c\u1ee7a d\u00e2y ch\u1eb1ng \u1ed5 ch\u1ea3o c\u00e1nh tay d\u01b0\u1edbi l\u00e0m thay \u0111\u1ed5i \u0111i\u1ec3m ti\u1ebfp x\u00fac sau tr\u00ean v\u00e0 l\u00e0m t\u0103ng l\u1ef1c x\u00e9 l\u00ean s\u1ee5n vi\u1ec1n tr\u00ean. T\u1ed5n th\u01b0\u01a1ng SLAP l\u00e0m t\u0103ng s\u1ee9c c\u0103ng tr\u00ean d\u1ea3i tr\u01b0\u1edbc c\u1ee7a d\u00e2y ch\u1eb1ng \u1ed5 ch\u1ea3o c\u00e1nh tay d\u01b0\u1edbi v\u00e0 do \u0111\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1ed9 v\u1eefng c\u1ee7a kh\u1edbp vai.<\/p>\n C\u00f3 hai nguy\u00ean nh\u00e2n ch\u00ednh d\u1eabn \u0111\u1ebfn r\u00e1ch s\u1ee5n vi\u1ec1n kh\u1edbp vai. \u0110\u00f3 l\u00e0: c\u0103ng c\u01a1 v\u00e0 ch\u1ea5n th\u01b0\u01a1ng t\u1eeb t\u01b0 th\u1ebf.<\/p>\n C\u0103ng c\u01a1<\/strong><\/p>\n S\u1ef1 c\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 t\u1ef1 ph\u00e1t k\u00e9o d\u00e0i l\u00e0 m\u1ed9t s\u1ef1 co c\u01a1<\/a> ch\u1ed1ng \u0111\u1ee1 kh\u00f4ng \u0111\u1eb3ng tr\u01b0\u01a1ng<\/p>\n \u0323(co c\u01a1 kh\u00f4ng c\u00f3 s\u1ef1 gi\u1ea3m \u0111\u00e1ng k\u1ec3 chi\u1ec1u d\u00e0i s\u1ee3i c\u01a1). Do kh\u00f4ng co ng\u1eafn c\u00e1c s\u1ee3i c\u01a1 n\u00ean kh\u00f4ng c\u00f3 s\u1ef1 bi\u1ebfn \u0111\u1ed5i kh\u1edbp trong c\u01a1 th\u1ec3, kh\u00f4ng c\u00f3 s\u1ef1 chuy\u1ec3n \u0111\u1ed9ng x\u1ea3y ra, nh\u01b0ng c\u00f3 s\u1ef1 t\u0103ng tr\u01b0\u1edfng l\u1ef1c t\u1eeb c\u00e1c s\u1ee3i ng\u1eafn l\u00e0m thay \u0111\u1ed5i t\u1ea5t c\u1ea3 c\u00e1c th\u00e0nh ph\u1ea7n h\u00f3a h\u1ecdc, \u0111i\u1ec7n c\u0169ng nh\u01b0 l\u00e0 chuy\u1ec3n h\u00f3a t\u1edbi m\u1ea1ch.<\/p>\n C\u00e1c b\u00e0i t\u1eadp c\u01a1 n\u1eb7ng n\u1ec1 c\u0169ng l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n \u0111au c\u01a1, \u0111au c\u00f3 th\u1ec3 k\u00e9o d\u00e0i trong v\u00e0i gi\u1edd sau khi ngh\u1ec9 do l\u00e0m \u0111\u1ee9t \u0111o\u1ea1n h\u1ec7 th\u1ed1ng b\u1edfi co c\u01a1 k\u00e9o d\u00e0i, nh\u1ea5t l\u00e0 trong th\u1ec3 thao. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 c\u01a1 ch\u1ebf ph\u1ea3n x\u1ea1, m\u00e0 trong \u0111\u00f3 c\u00f3 s\u1ef1 k\u00e9o c\u0103ng c\u1ee7a b\u1ed9 m\u00e1y golgi \u0111\u1ec3 ch\u1ed1ng l\u1ea1i s\u1ef1 co c\u01a1.<\/p>\n C\u00e1c s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a trong qu\u00e1 tr\u00ecnh co c\u01a1 nh\u01b0 \u201cc\u00e1c y\u1ebfu t\u1ed1 P\u201d, kali, acid lactic c\u0169ng tr\u1edf th\u00e0nh c\u00e1c y\u1ebfu t\u1ed1 k\u00edch th\u00edch c\u1ee5c b\u1ed9 c\u00e1c th\u1ee5 c\u1ea3m th\u1ec3 \u0111au.<\/p>\n M\u1ed9t s\u1ed1 co c\u01a1 th\u00e1i qu\u00e1 s\u1ebd l\u00e0m r\u00e1ch vi th\u1ec3 c\u00e1c s\u1ee3i c\u01a1, g\u00e2y ph\u00f9 n\u1ec1, vi\u00eam m\u00e0ng x\u01b0\u01a1ng c\u1ee7a c\u00e1c c\u01a1 g\u1eafn v\u1edbi c\u01a1 x\u01b0\u01a1ng v\u00e0 c\u00e1c t\u1ed5 ch\u1ee9c d\u01b0\u1edbi m\u00e0ng x\u01b0\u01a1ng, d\u1eabn t\u1edbi \u0111au v\u00e0 t\u0103ng c\u1ea3m gi\u00e1c \u0111au \u0111\u1edbn \u1edf nh\u1eefng ng\u01b0\u1eddi b\u1ecb ch\u1ea5n th\u01b0\u01a1ng<\/p>\n Ch\u1ea5n th\u01b0\u01a1ng t\u1eeb t\u01b0 th\u1ebf<\/strong><\/p>\n Trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y, c\u00f3 nhi\u1ec1u ho\u1ea1t \u0111\u1ed9ng ph\u1ea3i ch\u1ecbu t\u01b0 th\u1ebf \u01b0\u1ee1n vai qu\u00e1 m\u1ee9c ch\u1eb3ng h\u1ea1n nh\u01b0: t\u01b0 th\u1ebf ng\u1ed3i l\u00e0m vi\u1ec7c t\u1ea1i b\u00e0n m\u00e1y t\u00ednh, t\u01b0 th\u1ebf \u0111\u1ee9ng k\u00e9o d\u00e0i (c\u00e1c ng\u00e0nh ngh\u1ec1 l\u1ec5 t\u00e2n, ti\u1ebfp th\u1ecb,\u2026), c\u00e1c m\u00f4n th\u1ec3 thao d\u00f9ng nhi\u1ec1u l\u1ef1c \u1edf vai v\u00e0 c\u00e1nh tay (c\u1ea7u l\u00f4ng, tennis, b\u00f3ng chuy\u1ec1n, b\u00f3ng r\u1ed5,…) C\u00e1c t\u01b0 th\u1ebf n\u00e0y k\u00e9o d\u00e0i trong m\u1ed9t th\u1eddi gian d\u00e0i l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y ra r\u00e1ch s\u1ee5n vi\u1ec1n kh\u1edbp vai.<\/p>\n Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/strong><\/p>\n B\u1ec7nh s\u1eed<\/a> c\u00f3 th\u1ec3 l\u00e0m d\u1ea5y l\u00ean nghi ng\u1edd v\u1ec1 s\u1ef1 m\u1ea5t v\u1eefng kh\u1edbp vai. Tu\u1ed5i, ngh\u1ec1 nghi\u1ec7p, t\u00ecnh tr\u1ea1ng vi\u1ec7c l\u00e0m, m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng, tay thu\u1eadn v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 y t\u1ebf kh\u00e1c c\u1ee7a b\u1ec7nh nh\u00e2n r\u1ea5t h\u1eefu \u00edch trong vi\u1ec7c ph\u00e2n lo\u1ea1i b\u1ea3n ch\u1ea5t c\u1ee7a s\u1ef1 m\u1ea5t v\u1eefng. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u1ea5t \u0111\u1ecbnh, ch\u1eb3ng h\u1ea1n nh\u01b0 ch\u1ea5n th\u01b0\u01a1ng li\u00ean quan \u0111\u1ebfn c\u00f4ng vi\u1ec7c ho\u1eb7c nh\u1eefng v\u1ea5n \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn tranh ch\u1ea5p, c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nh\u1eadn th\u1ee9c c\u1ee7a b\u1ec7nh nh\u00e2n v\u1ec1 t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt c\u1ee7a h\u1ecd c\u0169ng nh\u01b0 mong \u0111\u1ee3i c\u1ee7a h\u1ecd v\u1ec1 s\u1ef1 ph\u1ee5c h\u1ed3i v\u00e0 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n T\u00ecm ki\u1ebfm c\u00e1c than phi\u1ec1n c\u1ee5 th\u1ec3. V\u00ed d\u1ee5, m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ch\u1ec9 ra r\u1eb1ng c\u00e1nh tay \u201cb\u1ea5t l\u1ef1c\u201d trong m\u1ed9t pha tranh b\u00f3ng. Tri\u1ec7u ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 b\u00e1n tr\u1eadt kh\u1edbp ch\u1ea5n th\u01b0\u01a1ng v\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng Bankart. M\u1ed9t v\u00ed d\u1ee5 kh\u00e1c l\u00e0 m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed t\u1eebng b\u1ecb m\u1eafc k\u1eb9t v\u00e0 sau \u0111\u00f3 t\u1ec9nh d\u1eady v\u1edbi c\u1ea3m gi\u00e1c kh\u1edbp b\u1ecb \u201csai ch\u1ed7\u201d. T\u00ecnh tr\u1ea1ng n\u00e0y cho th\u1ea5y tr\u1eadt kh\u1edbp ra sau do l\u1ef1c xoay b\u00ean trong kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u01b0\u1ee3t qua c\u00e1c c\u01a1 quay b\u00ean ngo\u00e0i y\u1ebfu h\u01a1n c\u1ee7a vai.<\/p>\n N\u1ebfu c\u01a1n \u0111au l\u00e0 y\u1ebfu t\u1ed1 ch\u00ednh g\u00e2y ra ph\u00e0n n\u00e0n c\u1ee7a b\u1ec7nh nh\u00e2n, th\u00ec ho\u1ea1t \u0111\u1ed9ng n\u00e0o g\u00e2y ra c\u01a1n \u0111au. H\u1ecfi c\u00e1c v\u1eadn \u0111\u1ed9ng vi\u00ean v\u1ec1 lo\u1ea1i th\u1ec3 thao, v\u1ecb tr\u00ed ch\u01a1i v\u00e0 th\u1eddi l\u01b0\u1ee3ng, t\u1ea7n su\u1ea5t v\u00e0 m\u1ee9c \u0111\u1ed9 tham gia. V\u00ed d\u1ee5, v\u1eadn \u0111\u1ed9ng vi\u00ean n\u00e9m, v\u1eadn \u0111\u1ed9ng vi\u00ean b\u01a1i l\u1ed9i ho\u1eb7c ng\u01b0\u1eddi ch\u01a1i qu\u1ea7n v\u1ee3t c\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n ch\u1ee9ng l\u1ecfng l\u1ebbo qu\u00e1 m\u1ee9c do vai c\u1ee7a h\u1ecd ph\u1ea3i ch\u1ecbu t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u1ea5n th\u01b0\u01a1ng nh\u1ecf l\u1eb7p \u0111i l\u1eb7p l\u1ea1i. K\u1ebft qu\u1ea3 l\u00e0 s\u1ef1 b\u00e1n tr\u1eadt vai t\u00e1i di\u1ec5n, c\u00f3 th\u1ec3 t\u1ea1o ra c\u1ea3m gi\u00e1c \u201cl\u1ecfng l\u1ebbo\u201d ho\u1eb7c \u201ctr\u01b0\u1ee3t\u201d khi ho\u1ea1t \u0111\u1ed9ng. Ngo\u00e0i ra, nh\u01b0 \u0111\u00e3 n\u00f3i tr\u01b0\u1edbc \u0111\u00e2y, hi\u1ec7n t\u01b0\u1ee3ng xung \u0111\u1ed9t \u201ckh\u00f3 tho\u00e1t\u201d th\u1ee9 ph\u00e1t c\u00f3 th\u1ec3 x\u1ea3y ra do s\u1ef1 m\u1ea5t \u1ed5n \u0111\u1ecbnh ph\u00eda tr\u01b0\u1edbc l\u00e0m gi\u1ea3m kh\u00f4ng gian d\u01b0\u1edbi m\u1ecfm c\u00f9ng, g\u00e2y \u0111au khi ho\u1ea1t \u0111\u1ed9ng qu\u00e1 \u0111\u1ea7u. H\u01a1n n\u1eefa, nh\u1eefng chuy\u1ec3n d\u1ecbch b\u00e1n tr\u1eadt n\u00e0y c\u00f3 th\u1ec3 t\u1ea1o ra t\u1ed5n th\u01b0\u01a1ng cho v\u00f9ng s\u1ee5n vi\u1ec1n, t\u1ea1o ra t\u1ed5n th\u01b0\u01a1ng SLAP. B\u00e1n tr\u1eadt ra sau c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf c\u00e1c v\u1eadn \u0111\u1ed9ng vi\u00ean c\u1ea7n chuy\u1ec3n \u0111\u1ed9ng c\u00e1nh tay l\u1eb7p \u0111i l\u1eb7p l\u1ea1i \u1edf ph\u00eda tr\u01b0\u1edbc c\u01a1 th\u1ec3, ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00e1c c\u1ea7u th\u1ee7 ti\u1ec1n \u0111\u1ea1o trong b\u00f3ng \u0111\u00e1 v\u00e0 b\u00f3ng chuy\u1ec1n, b\u00f3ng m\u1ec1m v\u00e0 b\u00f3ng ch\u00e0y. \u0110\u1eb7c bi\u1ec7t, c\u00e1c m\u00f4n th\u1ec3 thao n\u00e9m d\u1eabn \u0111\u1ebfn c\u00e1c than phi\u1ec1n v\u1ec1 \u0111au vai sau trong giai \u0111o\u1ea1n theo d\u00f5i, c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 b\u00e1n tr\u1eadt ph\u00eda sau v\u00e0 d\u1eabn \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng vi th\u1ec3 \u1edf ph\u1ee9c h\u1ee3p bao kh\u1edbp s\u1ee5n vi\u1ec1n sau.<\/p>\n Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/strong><\/p>\n \u0110\u00e1nh gi\u00e1 c\u00f3 h\u1ec7 th\u1ed1ng bao g\u1ed3m quan s\u00e1t c\u00e1c m\u00f4 h\u00ecnh chuy\u1ec3n \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng v\u00e0 teo c\u01a1, s\u1edd n\u1eafn \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh v\u1ecb tr\u00ed c\u00e1c v\u00f9ng \u0111au, \u0111\u00e1nh gi\u00e1 ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng c\u1ea3 ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng, \u0111o s\u1ee9c m\u1ea1nh c\u1ee7a c\u01a1 ch\u00f3p xoay<\/a>, \u0111\u00e1nh gi\u00e1 m\u1ea1ch m\u00e1u th\u1ea7n kinh v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 c\u00e1c nghi\u1ec7m ph\u00e1p \u0111\u1ec3 t\u00ecm s\u1ef1 b\u1ea5t \u1ed5n. Ki\u1ec3m tra vai \u0111\u1ed1i di\u1ec7n \u0111\u1ec3 so s\u00e1nh<\/p>\n Khi \u0111\u00e1nh gi\u00e1 chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a vai, h\u00e3y ghi ch\u00e9p c\u1ea9n th\u1eadn b\u1ea5t k\u1ef3 s\u1ef1 thay th\u1ebf chuy\u1ec3n \u0111\u1ed9ng b\u1ea3 vai l\u1ed3ng ng\u1ef1c b\u1eb1ng \u1ed5 ch\u1ea3o c\u00e1nh tay, \u0111u \u0111\u01b0a x\u01b0\u01a1ng vai v\u00e0 c\u00e1c d\u1ea1ng chuy\u1ec3n \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng kh\u00e1c. Teo c\u00e1c c\u01a1 quanh gai c\u00f3 th\u1ec3 cho th\u1ea5y m\u1ed9t v\u1ebft r\u00e1ch ch\u00f3p xoay ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh tr\u00ean vai. T\u01b0\u01a1ng t\u1ef1, teo c\u01a1 delta c\u00f3 th\u1ec3 ch\u1ec9 ra m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh n\u00e1ch.<\/p>\n \u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n \u0111\u1ec3 t\u00ecm c\u00e1c l\u1ecfng l\u1ebbo c\u1ee7a d\u00e2y ch\u1eb1ng n\u00f3i chung, bao g\u1ed3m kh\u1ea3 n\u0103ng du\u1ed7i khu\u1ef7u tay qu\u00e1 10\u00b0, \u00e1p ng\u00f3n tay<\/a> c\u00e1i v\u00e0o c\u1eb3ng tay, du\u1ed7i c\u00e1c kh\u1edbp c\u1ed5 tay tr\u00ean 90\u00b0 ho\u1eb7c ch\u1ea1m l\u00f2ng b\u00e0n tay c\u1ee7a m\u1ed7i b\u00e0n tay xu\u1ed1ng s\u00e0n trong khi gi\u1eef \u0111\u1ea7u g\u1ed1i du\u1ed7i. M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 m\u1ed1i li\u00ean h\u1ec7 tr\u1ef1c ti\u1ebfp n\u00e0o gi\u1eefa s\u1ef1 l\u1ecfng l\u1ebbo c\u1ee7a d\u00e2y ch\u1eb1ng n\u00f3i chung v\u00e0 s\u1ef1 m\u1ea5t \u1ed5n \u0111\u1ecbnh c\u1ee7a vai, nh\u01b0ng c\u00f3 m\u1ed9t s\u1ed1 m\u1ed1i li\u00ean quan gi\u1eefa s\u1ef1 qu\u00e1 d\u1ebbo v\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a bao kh\u1edbp \u1ed5 ch\u1ea3o c\u00e1nh tay.<\/p>\n M\u1ed9t b\u1ec7nh nh\u00e2n b\u1ecb tr\u1eadt kh\u1edbp ra tr\u01b0\u1edbc c\u1ea5p t\u00ednh, kh\u00f4ng t\u1ef1 n\u1eafn \u0111\u01b0\u1ee3c, gi\u1eef tay \u0111au trong t\u01b0 th\u1ebf d\u1ea1ng nh\u1eb9 v\u00e0 xoay trong. Tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n b\u1ea5t k\u1ef3 \u0111\u1ed9ng t\u00e1c n\u1eafn tr\u1eadt n\u00e0o, h\u00e3y ki\u1ec3m tra m\u1ea1ch m\u00e1u th\u1ea7n kinh c\u1ea9n th\u1eadn \u0111\u1ec3 lo\u1ea1i tr\u1eeb t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay v\u00e0 \u0111\u1eb7c bi\u1ec7t h\u01a1n l\u00e0 ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh n\u00e1ch. \u1ede nh\u1eefng ng\u01b0\u1eddi l\u1edbn h\u01a1n (> 60 tu\u1ed5i) ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi tr\u1ebb h\u01a1n \u0111\u00e3 b\u1ecb m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng n\u1eb7ng, h\u00e3y l\u01b0u \u00fd \u0111\u1ebfn kh\u1ea3 n\u0103ng g\u00e3y x\u01b0\u01a1ng<\/a> \u0111\u00f2n li\u00ean quan. Ch\u1ee5p X-quang<\/a> ki\u1ec3m tra l\u00e0 \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng tr\u01b0\u1edbc khi c\u1ed1 g\u1eafng n\u1eafn k\u00edn trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u01b0 v\u1eady.<\/p>\n Ch\u00fa \u00fd c\u1ea9n th\u1eadn \u0111\u1ebfn b\u1ec7nh nh\u00e2n b\u1ecb tr\u1eadt kh\u1edbp m\u1ea1n t\u00ednh (c\u1ed1 \u0111\u1ecbnh) kh\u00f4ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n. Tr\u1eadt kh\u1edbp th\u01b0\u1eddng \u1edf ph\u00eda sau, m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 \u1edf ph\u00eda tr\u01b0\u1edbc, v\u00e0 th\u01b0\u1eddng x\u1ea3y ra \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh s\u1eed ngh\u00e8o n\u00e0n do s\u1eed d\u1ee5ng r\u01b0\u1ee3u ho\u1eb7c sa s\u00fat tr\u00ed tu\u1ec7. \u1ede b\u1ec7nh nh\u00e2n b\u1ecb b\u00e1n tr\u1eadt ra sau c\u1ed1 \u0111\u1ecbnh, c\u00f3 h\u1ea1n ch\u1ebf xoay ngo\u00e0i so v\u1edbi vai \u0111\u1ed1i di\u1ec7n. Ngo\u00e0i ra, s\u1edd th\u1ea5y ph\u1eb3ng \u1edf ph\u00eda tr\u01b0\u1edbc c\u1ee7a vai v\u1edbi s\u1ef1 g\u1ed3 l\u00ean c\u1ee7a m\u1ecfm qu\u1ea1 v\u00e0 c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t s\u1ed1 \u0111i\u1ec3m h\u01a1i g\u1ed3 v\u00e0 tr\u00f2n \u1edf ph\u00eda sau c\u1ee7a vai. Vi\u1ec7c s\u1eed d\u1ee5ng l\u1ef1c qu\u00e1 m\u1ea1nh \u0111\u1ec3 c\u1ed1 g\u1eafng n\u1eafn k\u00edn m\u1ed9t b\u1ec7nh nh\u00e2n nh\u01b0 v\u1eady c\u00f3 nguy c\u01a1 g\u00e2y ch\u1ea5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u th\u1ea7n kinh ho\u1eb7c g\u00e3y x\u01b0\u01a1ng.<\/p>\n Sau khi ki\u1ec3m tra m\u1ea1ch m\u00e1u th\u1ea7n kinh c\u1ea9n th\u1eadn, \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i \u0111\u00e1nh gi\u00e1 ph\u1ea1m vi chuy\u1ec3n \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng. S\u1ef1 kh\u00e1c bi\u1ec7t gi\u1eefa chuy\u1ec3n \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng c\u00f3 th\u1ec3 g\u1ee3i \u00fd r\u00e1ch ch\u00f3p xoay k\u00e8m theo ho\u1eb7c ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh.<\/p>\n \u0110i\u1ec1u \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng l\u00e0 x\u00e1c \u0111\u1ecbnh v\u1ebft r\u00e1ch c\u01a1 d\u01b0\u1edbi vai trong tr\u01b0\u1eddng h\u1ee3p m\u1ea5t v\u1eefng kh\u1edbp vai, m\u00e0 th\u01b0\u1eddng xuy\u00ean b\u1ecb b\u1ecf s\u00f3t. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nh\u1eefng v\u1ebft r\u00e1ch nh\u01b0 v\u1eady \u0111\u00e3 t\u0103ng c\u1eed \u0111\u1ed9ng xoay ngo\u00e0i th\u1ee5 \u0111\u1ed9ng v\u1edbi c\u00e1nh tay \u0111\u01b0\u1ee3c \u00e1p s\u00e1t th\u00e2n m\u00ecnh, c\u0169ng nh\u01b0 c\u1ea3m gi\u00e1c lo s\u1ee3 li\u00ean quan \u0111\u1ebfn t\u01b0 th\u1ebf n\u00e0y.<\/p>\n \u0110\u00e1nh gi\u00e1 s\u1ee9c c\u01a1 c\u0169ng r\u1ea5t quan tr\u1ecdng. Y\u1ebfu xoay ngo\u00e0i \u0111\u00e1ng k\u1ec3 c\u00f3 th\u1ec3 ch\u1ec9 ra m\u1ed9t v\u1ebft r\u00e1ch ch\u00f3p xoay. T\u01b0\u01a1ng t\u1ef1, y\u1ebfu \u0111\u1ed9ng t\u00e1c xoay trong c\u00f3 th\u1ec3 do r\u00e1ch c\u01a1 d\u01b0\u1edbi vai. Trong t\u00ecnh hu\u1ed1ng n\u00e0y, b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u lift-off d\u01b0\u01a1ng t\u00ednh k\u00e8m theo. N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ee7 kh\u1ea3 n\u0103ng xoay trong \u0111\u1ec3 th\u1ef1c hi\u1ec7n th\u1eed nghi\u1ec7m n\u00e0y, thay v\u00e0o \u0111\u00f3 h\u00e3y th\u1ef1c hi\u1ec7n \u0111\u1ed9ng t\u00e1c \u1ea5n b\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng b\u1ec7nh nh\u00e2n k\u00e9o c\u1eb3ng tay theo h\u01b0\u1edbng ra sau v\u1ec1 ph\u00eda b\u1ee5ng gi\u1eefa trong khi v\u1eabn gi\u1eef khu\u1ef7u tay g\u1eadp v\u1ec1 ph\u00eda tr\u01b0\u1edbc so v\u1edbi \u0111i\u1ec3m n\u00e0y. N\u1ebfu khu\u1ef7u tay v\u1eabn \u1edf ph\u00eda sau so v\u1edbi ph\u00eda tr\u01b0\u1edbc c\u1ee7a b\u1ee5ng gi\u1eefa, c\u00f3 kh\u1ea3 n\u0103ng b\u1ecb r\u00e1ch g\u00e2n d\u01b0\u1edbi vai.<\/p>\n C\u00e1c th\u1ee7 thu\u1eadt k\u00edch th\u00edch kh\u00e1c nhau v\u00e0 c\u00e1c b\u00e0i ki\u1ec3m tra ng\u0103n k\u00e9o \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 chuy\u1ec3n d\u1ecbch ch\u1ecfm c\u00e1nh tay v\u00e0 h\u01b0\u1edbng c\u1ee7a chuy\u1ec3n \u0111\u1ed9ng n\u00e0y. Neer v\u00e0 Foster ban \u0111\u1ea7u m\u00f4 t\u1ea3 th\u1eed nghi\u1ec7m lo s\u1ee3 cho s\u1ef1 b\u1ea5t \u1ed5n \u0111\u1ecbnh ph\u00eda tr\u01b0\u1edbc. Khi b\u1ec7nh nh\u00e2n ng\u1ed3i ho\u1eb7c \u0111\u1ee9ng, \u0111\u1eb7t vai c\u00f3 tri\u1ec7u ch\u1ee9ng \u1edf t\u01b0 th\u1ebf d\u1ea1ng 90\u00b0 v\u00e0 xoay ngo\u00e0i t\u1ed1i \u0111a. Sau \u0111\u00f3, di chuy\u1ec3n c\u00e1nh tay ra sau m\u1eb7t ph\u1eb3ng c\u1ee7a x\u01b0\u01a1ng b\u1ea3 vai v\u00e0 t\u00e1c \u0111\u1ed9ng m\u1ed9t l\u1ef1c ra tr\u01b0\u1edbc l\u00ean ch\u1ecfm c\u00e1nh tay. B\u1ec7nh nh\u00e2n r\u00fat tay kh\u1ecfi ng\u01b0\u1eddi kh\u00e1m ho\u1eb7c ph\u00e0n n\u00e0n v\u1ec1 c\u1ea3m gi\u00e1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh \u1edf vai th\u1ec3 hi\u1ec7n s\u1ef1 lo s\u1ee3.<\/p>\n Than phi\u1ec1n v\u1ec1 c\u01a1n \u0111au kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho t\u00ecnh tr\u1ea1ng m\u1ea5t v\u1eefng v\u00e0 tr\u00ean th\u1ef1c t\u1ebf c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n v\u1edbi c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nh\u01b0 vi\u00eam kh\u1edbp<\/a> ho\u1eb7c b\u1ec7nh ch\u00f3p xoay. Kvitne v\u00e0 Jobe \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t m\u1ed9t s\u1eeda \u0111\u1ed5i c\u1ee7a th\u1ee7 thu\u1eadt n\u00e0y \u0111\u1ec3 t\u0103ng t\u00ednh \u0111\u1eb7c hi\u1ec7u c\u1ee7a n\u00f3 \u0111\u1ed1i v\u1edbi s\u1ef1 m\u1ea5t \u1ed5n \u0111\u1ecbnh ph\u00eda tr\u01b0\u1edbc. \u0110\u1eb7t b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf n\u1eb1m ng\u1eeda v\u00e0 th\u1ef1c hi\u1ec7n ki\u1ec3m tra m\u1ee9c \u0111\u1ed9 lo s\u1ee3 nh\u01b0 \u0111\u00e3 m\u00f4 t\u1ea3 \u1edf tr\u00ean. H\u1ecfi xem b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3m gi\u00e1c b\u1ea5t \u1ed5n hay ch\u1ec9 \u0111\u01a1n gi\u1ea3n l\u00e0 \u0111au. \u0110\u1eb7t l\u1ef1c ra sau l\u00ean c\u00e1nh tay, v\u00e0 h\u1ecfi xem li\u1ec7u l\u1ef1c n\u00e0y c\u00f3 l\u00e0m gi\u1ea3m c\u1ea3m gi\u00e1c lo s\u1ee3 hay \u0111au \u0111\u1edbn hay kh\u00f4ng. \u201cTh\u1ee7 thu\u1eadt v\u00e0o l\u1ea1i\u201d n\u00e0y l\u00e0m t\u0103ng t\u00ednh \u0111\u1eb7c hi\u1ec7u c\u1ee7a ch\u1ea9n \u0111o\u00e1n b\u1ea5t \u1ed5n n\u1ebfu b\u1ec7nh nh\u00e2n b\u00e1o c\u00e1o gi\u1ea3m lo s\u1ee3. N\u1ebfu \u0111\u1ed9ng t\u00e1c n\u00e0y ch\u1ec9 \u0111\u01a1n gi\u1ea3n l\u00e0 gi\u1ea3m \u0111au, th\u00ec n\u00f3 kh\u00f4ng ph\u1ea3i l\u00e0 kh\u00f4ng \u1ed5n \u0111\u1ecbnh v\u00e0 c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn nhi\u1ec1u b\u1ec7nh l\u00fd kh\u00e1c, bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng SLAP ho\u1eb7c h\u1ed9i ch\u1ee9ng xung \u0111\u1ed9t.<\/p>\n S\u1ef1 kh\u00f4ng nh\u1ea5t qu\u00e1n v\u1edbi th\u1eed nghi\u1ec7m lo s\u1ee3 khi\u1ebfn Gerber v\u00e0 Ganz ph\u00e1t tri\u1ec3n th\u1eed nghi\u1ec7m ng\u0103n k\u00e9o tr\u01b0\u1edbc v\u00e0 sau \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 vai c\u00f3 d\u1ecbch chuy\u1ec3n qu\u00e1 nhi\u1ec1u so v\u1edbi b\u00ean c\u1ea1nh hay kh\u00f4ng. Nh\u1eefng ng\u01b0\u1eddi kh\u00e1c \u0111\u00e3 ph\u00e1t hi\u1ec7n ra gi\u00e1 tr\u1ecb c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p ki\u1ec3m tra n\u00e0y v\u00e0 \u0111\u00e3 ph\u00e1t tri\u1ec3n c\u00e1c thang \u0111i\u1ec3m cho m\u1ee9c \u0111\u1ed9 l\u1ecfng l\u1ebbo \u1edf vai. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong qu\u00e1 tr\u00ecnh ki\u1ec3m tra d\u01b0\u1edbi g\u00e2y m\u00ea \u0111\u1ec3 x\u00e1c nh\u1eadn m\u1ee9c \u0111\u1ed9 v\u00e0 h\u01b0\u1edbng b\u1ea5t \u1ed5n c\u1ee7a vai.<\/p>\n Altchek, Hawkins v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t m\u1ed9t thang ph\u00e2n lo\u1ea1i cho s\u1ef1 d\u1ecbch chuy\u1ec3n c\u1ee7a ch\u1ecfm c\u00e1nh tay v\u1edbi \u1ed5 ch\u1ea3o. T\u00ednh kh\u00f4ng \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean thang \u0111i\u1ec3m t\u1eeb 0 \u0111\u1ebfn 3+ cho c\u1ea3 ba h\u01b0\u1edbng. \u0110\u1ed1i v\u1edbi th\u1eed nghi\u1ec7m ng\u0103n k\u00e9o tr\u01b0\u1edbc v\u00e0 sau, \u0111i\u1ec3m 0 th\u1ec3 hi\u1ec7n kh\u00f4ng c\u00f3 d\u1ecbch chuy\u1ec3n ch\u1ecfm, trong khi chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a ch\u1ecfm l\u00ean tr\u00ean nh\u01b0ng kh\u00f4ng qua v\u00e0nh \u1ed5 ch\u1ea3o th\u1ec3 hi\u1ec7n s\u1ef1 kh\u00f4ng \u1ed5n \u0111\u1ecbnh t\u1eeb 1+. S\u1ef1 d\u1ecbch chuy\u1ec3n c\u1ee7a ch\u1ecfm qua v\u00e0nh \u1ed5 ch\u1ea3o v\u1edbi s\u1ef1 t\u1ef1 n\u1eafn l\u1ea1i \u0111i k\u00e8m v\u1edbi gi\u1ea3m l\u1ef1c t\u00e1i hi\u1ec7n m\u1ea5t v\u1eefng 2+. Tr\u1eadt kh\u1edbp Frank v\u00e0 kh\u00f3a ch\u1ecfm c\u00e1nh tay qu\u00e1 v\u00e0nh \u1ed5 ch\u1ea3o \u0111\u01b0\u1ee3c x\u1ebfp lo\u1ea1i l\u00e0 kh\u00f4ng \u1ed5n \u0111\u1ecbnh 3+.<\/p>\n M\u1ed9t s\u1eeda \u0111\u1ed5i c\u1ee7a b\u00e0i ki\u1ec3m tra ng\u0103n k\u00e9o sau cho ph\u00e9p ng\u01b0\u1eddi ki\u1ec3m tra g\u1ee3i ra s\u1ef1 lo l\u1eafng ph\u00eda sau. Th\u1ef1c hi\u1ec7n s\u1eeda \u0111\u1ed5i n\u00e0y b\u1eb1ng c\u00e1ch \u0111\u1eb7t c\u00e1nh tay c\u1ee7a b\u1ec7nh nh\u00e2n \u1edf t\u01b0 th\u1ebf g\u1eadp ra tr\u01b0\u1edbc 90\u00b0 v\u00e0 kh\u00e9p trong khi \u00e1p d\u1ee5ng m\u1ed9t l\u1ef1c d\u1ecdc tr\u1ee5c xu\u1ed1ng x\u01b0\u01a1ng c\u00e1nh tay. \u0110au v\u00e0 c\u00f3 th\u1ec3 s\u1edd th\u1ea5y s\u1ef1 tr\u01b0\u1ee3t v\u00e0 l\u00e1ch c\u00e1ch cho th\u1ea5y ch\u1ea5n th\u01b0\u01a1ng v\u00e0 s\u1ef1 b\u1ea5t \u1ed5n c\u1ee7a s\u1ee5n vi\u1ec1n sau.<\/p>\n M\u1ed9t s\u1eeda \u0111\u1ed5i c\u1ee7a th\u1eed nghi\u1ec7m n\u00e0y, \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u1eed nghi\u1ec7m gi\u1eadt (sulcus), \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 cho s\u1ef1 m\u1ea5t v\u1eefng ph\u00eda sau. Khi b\u1ec7nh nh\u00e2n ng\u1ed3i, d\u00f9ng m\u1ed9t tay d\u1ea1ng vai theo tr\u1ee5c h\u01b0\u1edbng v\u00e0o \u1ed5 ch\u1ea3o v\u00e0 d\u00f9ng tay kia s\u1edd n\u1eafn ph\u1ea7n sau c\u1ee7a vai. Sau \u0111\u00f3, \u0111\u01b0a c\u00e1nh tay kh\u00e9p ngang ra tr\u01b0\u1edbc m\u1eb7t ph\u1eb3ng x\u01b0\u01a1ng b\u1ea3 vai; ch\u1ecfm c\u00e1nh tay c\u00f3 th\u1ec3 tr\u1eadt ra sau. Sau \u0111\u00f3, \u0111\u01b0a ch\u1ecfm ra sau m\u1eb7t ph\u1eb3ng x\u01b0\u01a1ng b\u1ea3 vai; ch\u1ecfm c\u00f3 th\u1ec3 tr\u01b0\u1ee3t nhanh v\u00e0o \u1ed5 ch\u1ea3o. M\u1ed9t s\u1ef1 d\u1ecbch chuy\u1ec3n c\u00f3 th\u1ec3 s\u1edd th\u1ea5y v\u00e0 \u0111au \u0111i k\u00e8m cho th\u1eed nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh.<\/p>\n D\u1ea5u hi\u1ec7u sulcus v\u1ec1 c\u01a1 b\u1ea3n l\u00e0 m\u1ed9t ph\u00e9p th\u1eed ng\u0103n k\u00e9o d\u01b0\u1edbi. Th\u1eadt kh\u00f4ng may, m\u1ed9t quan ni\u1ec7m sai l\u1ea7m ph\u1ed5 bi\u1ebfn cho r\u1eb1ng d\u1ea5u hi\u1ec7u sulcus l\u1edbn kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, do \u0111\u00f3, ch\u1ec9 ra t\u00ecnh tr\u1ea1ng l\u1ecfng l\u1ebbo kh\u1edbp v\u1ed1n c\u00f3, l\u00e0 m\u1ed9t ph\u00e1t hi\u1ec7n d\u01b0\u01a1ng t\u00ednh. \u0110i\u1ec3m m\u1ea5u ch\u1ed1t l\u00e0 thao t\u00e1c n\u00e0y ph\u1ea3i li\u00ean quan \u0111\u1ebfn c\u01a1n \u0111au v\u00e0 ph\u1ea3i t\u00e1i t\u1ea1o c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 c\u00f3 li\u00ean quan v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng nh\u01b0 m\u1ed9t ph\u00e1t hi\u1ec7n c\u1ee7a s\u1ef1 b\u1ea5t \u1ed5n d\u01b0\u1edbi. Th\u1ef1c hi\u1ec7n th\u1eed nghi\u1ec7m n\u00e0y v\u1edbi b\u1ec7nh nh\u00e2n ng\u1ed3i v\u00e0 c\u00e1nh tay \u0111\u01b0\u1ee3c kh\u00e9p v\u00e0o th\u00e2n m\u00ecnh. Xoay vai r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 b\u1ea5t \u1ed5n c\u1ee7a kh\u1edbp vai. \u0110\u1ea7u ti\u00ean, v\u1edbi c\u00e1nh tay \u1edf v\u1ecb tr\u00ed xoay trung t\u00ednh, k\u00e9o ch\u1ecfm xu\u1ed1ng d\u01b0\u1edbi, v\u00e0 \u01b0\u1edbc t\u00ednh kho\u1ea3ng c\u00e1ch gi\u1eefa m\u1ecfm c\u00f9ng v\u00e0 ch\u1ecfm. Ph\u00e2n theo thang \u0111i\u1ec3m 0 \u0111\u1ebfn 3+: Kho\u1ea3ng c\u00e1ch 1 cm l\u00e0 1+, 2 cm l\u00e0 2+ v\u00e0 3 cm l\u00e0 3+. V\u1ec1 m\u1eb7t gi\u1ea3i ph\u1eabu, d\u1ea5u hi\u1ec7u sulcus l\u1edbn h\u01a1n 2+ cho th\u1ea5y bao kh\u1edbp c\u00f3 dung l\u01b0\u1ee3ng v\u00e0 \u0111\u1ed9 l\u1ecfng l\u1ebbo \u0111\u1eb7c hi\u1ec7u c\u1ee7a v\u00f9ng bao kh\u1edbp tr\u01b0\u1edbc tr\u00ean (kho\u1ea3ng xoay). Xoay ngo\u00e0i c\u00e1nh tay v\u00e0 l\u1eb7p l\u1ea1i b\u00e0i ki\u1ec3m tra. N\u1ebfu d\u1ea5u hi\u1ec7u sulcus v\u1eabn l\u1edbn h\u01a1n 2+ v\u1edbi c\u00e1nh tay xoay ngo\u00e0i, th\u00ec c\u00f3 s\u1ef1 thi\u1ebfu h\u1ee5t r\u00f5 r\u1ec7t c\u1ee7a bao kh\u1edbp tr\u00ean v\u00e0 c\u00f3 th\u1ec3 c\u00f3 khuy\u1ebft kho\u1ea3ng xoay l\u1edbn trong bao kh\u1edbp. \u0110\u00e2y l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a vi\u1ec7c t\u1ed5n th\u01b0\u01a1ng d\u00e2y ch\u1eb1ng \u1ed5 ch\u1ea3o tr\u00ean v\u00e0 gi\u1eefa, c\u0169ng nh\u01b0 d\u00e2y ch\u1eb1ng qu\u1ea1 c\u00e1nh tay. V\u1edbi th\u00f4ng tin n\u00e0y tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt, b\u1ea1n s\u1ebd bi\u1ebft r\u1eb1ng ph\u1eabu thu\u1eadt t\u00e1i t\u1ea1o v\u00f9ng n\u00e0y v\u1edbi s\u1ef1 d\u1ecbch chuy\u1ec3n bao kh\u1edbp ph\u1ea3i l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a ph\u1eabu thu\u1eadt.<\/p>\n B\u1ed1n lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng \u0111a h\u01b0\u1edbng (MDI) kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3:<\/p>\n K\u1ec3 t\u1eeb khi m\u00f4 t\u1ea3 b\u1ec7nh l\u00fd s\u1ee5n vi\u1ec1n tr\u00ean c\u1ee7a Andrews v\u00e0 c\u1ed9ng s\u1ef1 n\u0103m 1985 v\u00e0 t\u1ed5n th\u01b0\u01a1ng SLAP c\u1ee7a Snyder v\u00e0 c\u1ed9ng s\u1ef1 v\u00e0o n\u0103m 1990, m\u1ed9t s\u1ed1 k\u1ef9 thu\u1eadt kh\u00e1m \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd n\u00e0y. Andrews cho bi\u1ebft b\u1ec7nh nh\u00e2n b\u1ecb \u0111au t\u0103ng l\u00ean khi g\u1eadp v\u00e0 kh\u00e9p vai ho\u00e0n to\u00e0n, k\u00e8m theo \u0111\u00f3 l\u00e0 g\u00e0i v\u00e0 b\u1eadt ra. Snyder cho bi\u1ebft b\u1ec7nh nh\u00e2n b\u1ecb \u0111au khi g\u1eadp vai \u0111\u1ed1i kh\u00e1ng b\u1eb1ng c\u00e1ch du\u1ed7i khu\u1ef7u tay v\u00e0 ng\u1eeda c\u1eb3ng tay (th\u1eed nghi\u1ec7m \u0111\u1ed9 c\u0103ng c\u01a1 nh\u1ecb \u0111\u1ea7u).<\/p>\n M\u1ed9t th\u1eed nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n h\u1eefu \u00edch kh\u00e1c l\u00e0 th\u1eed nghi\u1ec7m n\u00e9n-quay. Khi b\u1ec7nh nh\u00e2n n\u1eb1m ng\u1eeda, d\u1ea1ng vai 90\u00b0, g\u1eadp khu\u1ef7u 90\u00b0. \u00c1p d\u1ee5ng m\u1ed9t l\u1ef1c n\u00e9n l\u00ean c\u00e1nh tay \u0111\u1ec3 gi\u1eef s\u1ee5n vi\u1ec1n b\u1ecb r\u00e1ch (gi\u1ed1ng nh\u01b0 th\u1eed nghi\u1ec7m McMurray \u0111\u1ed1i v\u1edbi g\u1ed1i). O \u2018Brien v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u1ec1 xu\u1ea5t m\u1ed9t th\u1ee7 thu\u1eadt m\u00e0 h\u1ecd tin l\u00e0 ch\u00ednh x\u00e1c \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u00ean. \u0110\u1eb7t vai c\u1ee7a b\u1ec7nh nh\u00e2n trong t\u01b0 th\u1ebf g\u1eadp v\u1ec1 ph\u00eda tr\u01b0\u1edbc 90\u00b0 v\u00e0 sau \u0111\u00f3 kh\u00e9p qua ng\u01b0\u1eddi. Y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n g\u1eadp c\u00e1nh tay h\u01a1n n\u1eefa \u0111\u1ec3 ch\u1ed1ng l\u1ea1i l\u1ef1c c\u1ea3n khi xoay trong v\u00e0 sau \u0111\u00f3 xoay ngo\u00e0i. N\u1ebfu \u0111au x\u1ea3y ra khi xoay trong nh\u01b0ng kh\u00f4ng \u0111au khi xoay ngo\u00e0i, th\u00ec th\u1eed nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh. Th\u1eadt kh\u00f4ng may, th\u1eed nghi\u1ec7m n\u00e0y kh\u00f4ng ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c gi\u1eefa b\u1ec7nh vi\u00eam kh\u1edbp c\u00f9ng \u0111\u00f2n v\u00e0 r\u00e1ch s\u1ee5n vi\u1ec1n tr\u00ean. Tuy nhi\u00ean, th\u1eed nghi\u1ec7m n\u00e0y h\u1eefu \u00edch h\u01a1n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p kh\u00e1c \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf tr\u00ean.<\/p>\n Ch\u1ee5p X-quang t\u1ed1i thi\u1ec3u l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 tr\u1eadt kh\u1edbp c\u1ea5p t\u00ednh ho\u1eb7c nghi ng\u1edd b\u00e1n tr\u1eadt \u1edf t\u01b0 th\u1ebf ch\u1ee5p tr\u01b0\u1edbc sau (AP) v\u00e0 n\u00e1ch. Nh\u1eefng h\u00ecnh \u1ea3nh n\u00e0y s\u1ebd cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u1ecb tr\u00ed c\u1ee7a ch\u1ecfm c\u00e1nh tay so v\u1edbi \u1ed5 ch\u1ea3o. T\u01b0 th\u1ebf ch\u1ee5p b\u1ea3 vai Y c\u0169ng c\u00f3 th\u1ec3 cung c\u1ea5p th\u00f4ng tin h\u1eefu \u00edch v\u1ec1 v\u1ecb tr\u00ed c\u1ee7a ch\u1ecfm c\u00e1nh tay, nh\u01b0ng n\u00f3 kh\u00f4ng ch\u00ednh x\u00e1c b\u1eb1ng t\u01b0 th\u1ebf n\u00e1ch. N\u1ebfu kh\u00f4ng th\u1ec3 c\u00f3 \u0111\u01b0\u1ee3c th\u1ebf n\u00e1ch ti\u00eau chu\u1ea9n, th\u00ec t\u01b0 th\u1ebf n\u00e1ch Velpeau m\u00e0 kh\u00f4ng c\u1ea7n th\u00e1o c\u00e1nh tay c\u1ee7a b\u1ec7nh nh\u00e2n ra kh\u1ecfi d\u00e2y treo s\u1ebd l\u00e0 \u0111\u1ee7.<\/p>\n T\u01b0 th\u1ebf ch\u1ee5p AP c\u1ee7a vai v\u1edbi c\u00e1nh tay xoay trong c\u00f3 th\u1ec3 cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng Hill \u2013 Sachs. T\u01b0 th\u1ebf g\u00f3c Stryker c\u0169ng s\u1ebd cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng Hill \u2013 Sachs.<\/p>\n T\u01b0 th\u1ebf n\u00e1ch West Point c\u00f3 th\u1ec3 h\u1eefu \u00edch \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n nghi ng\u1edd c\u00f3 m\u1ed9t giai \u0111o\u1ea1n b\u1ea5t \u1ed5n. Ch\u1ee5p v\u1edbi b\u1ec7nh nh\u00e2n n\u1eb1m s\u1ea5p \u0111\u1ec3 \u1ed5 ch\u1ea3o tr\u01b0\u1edbc \u0111\u01b0\u1ee3c hi\u1ec3n th\u1ecb m\u00e0 kh\u00f4ng c\u00f3 b\u00f3ng m\u1ecfm c\u00f9ng ch\u1ed3ng l\u00ean.<\/p>\n C\u00e1c k\u1ef9 thu\u1eadt h\u00ecnh \u1ea3nh b\u1ed5 tr\u1ee3 r\u1ea5t h\u1eefu \u00edch khi c\u1ea7n th\u00eam th\u00f4ng tin v\u1ec1 m\u1ed1i quan h\u1ec7 v\u00e0 c\u1ea5u tr\u00fac ba chi\u1ec1u c\u1ee7a kh\u1edbp ho\u1eb7c x\u00e1c nh\u1eadn s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng Bankart. Ch\u1ee5p c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n (CT) cho th\u1ea5y c\u00e1c ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c b\u1ea5t th\u01b0\u1eddng \u1edf x\u01b0\u01a1ng bao g\u1ed3m gi\u1ea3m s\u1ea3n \u1ed5 ch\u1ea3o, d\u1ecb t\u1eadt b\u1ea9m sinh, b\u1ea5t th\u01b0\u1eddng m\u1eafc ph\u1ea3i do x\u00f3i m\u00f2n v\u00e0 g\u00e3y v\u00e0nh \u1ed5 ch\u1ea3o. Ngo\u00e0i ra, n\u00f3 cho ph\u00e9p \u0111o k\u00edch th\u01b0\u1edbc c\u1ee7a khuy\u1ebft ch\u1ecfm c\u00e1nh tay (t\u1ed5n th\u01b0\u01a1ng Hill \u2013 Sachs) trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u1ed5n \u0111\u1ecbnh m\u1ea1n t\u00ednh. Khi k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c c\u1ea3n quang n\u1ed9i kh\u1edbp, ch\u1ee5p CT kh\u1edbp c\u0169ng cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng Bankart v\u00e0 x\u00f3i m\u00f2n kh\u1edbp.<\/p>\n Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 gadolinium \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng, m\u1eb7c d\u00f9 kh\u00f4ng may l\u00e0 n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 m\u1ed9t c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc trong vi\u1ec7c \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n. Thay v\u00e0o \u0111\u00f3, vai tr\u00f2 c\u1ee7a n\u00f3 n\u00ean l\u00e0 x\u00e1c nh\u1eadn s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 c\u1ea7n x\u1eed tr\u00ed ph\u1eabu thu\u1eadt. N\u00f3 ch\u00ednh x\u00e1c trong vi\u1ec7c ph\u00e1t hi\u1ec7n b\u1ec7nh l\u00fd s\u1ee5n vi\u1ec1n. Nh\u1eefng ti\u1ebfn b\u1ed9 g\u1ea7n \u0111\u00e2y trong c\u00f4ng ngh\u1ec7 MRI nh\u01b0 quay nhanh \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao v\u00e0 h\u00ecnh \u1ea3nh d\u1ea3i \u00e2m l\u00e0m cho n\u00f3 \u0111\u1eb7c bi\u1ec7t h\u1eefu d\u1ee5ng \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u1ee5n vi\u1ec1n tr\u01b0\u1edbc v\u00e0 tr\u00ean.<\/p>\n Ch\u1ea9n \u0111o\u00e1n sai l\u1ea7m d\u1eabn \u0111\u1ebfn vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng hi\u1ec7u qu\u1ea3. B\u1ec7nh nh\u00e2n ho\u1eb7c b\u00e1c s\u0129 c\u00f3 th\u1ec3 m\u1eafc nh\u1eefng l\u1ed7i n\u00e0y. M\u1ed9t k\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng b\u1eaft \u0111\u1ea7u v\u1edbi m\u1ed9t ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c sau \u0111\u00f3 l\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 c\u1ea7n thi\u1ebft cho b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 \u0111\u00f3.<\/p>\n \u0110i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n<\/strong><\/p>\n C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 ti\u1ec1n s\u1eed t\u1ef1 nhi\u00ean c\u1ee7a m\u1ea5t v\u1eefng kh\u1edbp vai do ch\u1ea5n th\u01b0\u01a1ng cho th\u1ea5y t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t cao khi \u0111i\u1ec1u tr\u1ecb kh\u00f4ng ph\u1eabu thu\u1eadt. Rowe v\u00e0 Sakellarides b\u00e1o c\u00e1o t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t l\u00e0 58% \u1edf 398 b\u1ec7nh nh\u00e2n v\u1edbi 53% theo d\u00f5i. C\u00e1c nghi\u00ean c\u1ee9u sau \u0111\u00f3 \u0111\u00e3 x\u00e1c minh xu h\u01b0\u1edbng n\u00e0y. M\u1ed9t nghi\u00ean c\u1ee9u l\u1edbn c\u1ee7a v\u00f9ng Scandinavi cho r\u1eb1ng tu\u1ed5i c\u00e0ng tr\u1ebb t\u00e1i ph\u00e1t c\u00e0ng cao \u0111\u1eb7c bi\u1ec7t l\u1ee9a tu\u1ed5i ch\u1ea5n th\u01b0\u01a1ng d\u01b0\u1edbi 20 tu\u1ed5i. Hovelius v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o v\u1ec1 vi\u1ec7c theo d\u00f5i 10 n\u0103m tr\u00ean 245 b\u1ec7nh nh\u00e2n v\u1edbi 247 tr\u01b0\u1eddng h\u1ee3p tr\u1eadt kh\u1edbp nguy\u00ean ph\u00e1t. Tr\u1eadt kh\u1edbp t\u00e1i ph\u00e1t c\u1ea7n ph\u1eabu thu\u1eadt x\u1ea3y ra \u1edf 34% trong s\u1ed1 99 vai \u1edf \u0111\u1ed9 tu\u1ed5i 12 \u2013 22 tu\u1ed5i, 28% trong s\u1ed1 57 vai \u1edf \u0111\u1ed9 tu\u1ed5i 23 \u2013 29 v\u00e0 9% trong s\u1ed1 91 vai \u1edf \u0111\u1ed9 tu\u1ed5i 30 \u2013 40.<\/p>\n M\u1eb7c d\u00f9 tuy\u00ean b\u1ed1 ban \u0111\u1ea7u c\u1ee7a Watson-Jones v\u00e0o n\u0103m 1948 r\u1eb1ng vi\u1ec7c b\u1ea5t \u0111\u1ed9ng<\/a> ho\u00e0n to\u00e0n trong v\u00f2ng 4 tu\u1ea7n t\u1ea1o ra s\u1ef1 \u1ed5n \u0111\u1ecbnh ho\u00e0n to\u00e0n, nh\u1eefng ng\u01b0\u1eddi kh\u00e1c \u0111\u00e3 kh\u00f4ng b\u00e1o c\u00e1o k\u1ebft qu\u1ea3 th\u00e0nh c\u00f4ng nh\u01b0 v\u1eady. Tr\u00ean th\u1ef1c t\u1ebf, th\u00e0nh c\u00f4ng c\u1ee7a vi\u1ec7c c\u1ed1 \u0111\u1ecbnh c\u00f3 th\u1ec3 thay \u0111\u1ed5i. Rowe v\u00e0 Sakellarides b\u00e1o c\u00e1o r\u1eb1ng b\u1ea5t \u0111\u1ed9ng trong 3 tu\u1ea7n l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t. Henry v\u00e0 Genung b\u00e1o c\u00e1o kh\u00f4ng c\u00f3 s\u1ef1 c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 khi b\u1ea5t \u0111\u1ed9ng. Aronen v\u00e0 Regan nh\u1eadn th\u1ea5y t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t gi\u1ea3m xu\u1ed1ng 25% n\u1ebfu l\u1ea7n \u0111\u1ea7u b\u1ecb tr\u1eadt kh\u1edbp \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c b\u00e0i t\u1eadp \u0111\u1eb3ng tr\u01b0\u1eddng, \u0111\u1eb3ng tr\u01b0\u01a1ng v\u00e0 \u0111\u1eb3ng \u0111\u1ed9ng. Burkhead v\u00e0 Rockwood \u0111\u00e3 ch\u1ec9 \u0111\u1ecbnh m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh t\u1eadp tr\u1ecb li\u1ec7u vai cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea5n th\u01b0\u01a1ng ho\u1eb7c kh\u00f4ng ch\u1ea5n th\u01b0\u01a1ng. Trong nh\u00f3m b\u00e1n tr\u1eadt sau ch\u1ea5n th\u01b0\u01a1ng, 16% cho k\u1ebft qu\u1ea3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi ch\u01b0\u01a1ng tr\u00ecnh ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/a>, trong khi 87% nh\u00f3m b\u00e1n tr\u1eadt kh\u00f4ng ch\u1ea5n th\u01b0\u01a1ng kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 t\u00e2m l\u00fd c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t \u0111\u1ebfn xu\u1ea5t s\u1eafc. Hovelius v\u00e0 c\u1ed9ng s\u1ef1 b\u00e1o c\u00e1o r\u1eb1ng lo\u1ea1i tr\u1eadt v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ec9 l\u1ec7 t\u00e1i ph\u00e1t.<\/p>\n Nh\u01b0 v\u1eady, r\u00f5 r\u00e0ng c\u00e1c y\u1ebfu t\u1ed1 quan tr\u1ecdng nh\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00e1i ph\u00e1t b\u1ea5t \u1ed5n sau ch\u1ea5n th\u01b0\u01a1ng l\u00e0 tu\u1ed5i t\u00e1c v\u00e0 m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng.<\/p>\n \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/strong><\/p>\n Ph\u1eabu thu\u1eadt th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o n\u1ebfu m\u1ea5t v\u1eefng t\u00e1i ph\u00e1t d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ed1t b\u1eb1ng v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 \u0111i\u1ec1u ch\u1ec9nh ho\u1ea1t \u0111\u1ed9ng. M\u1ee5c ti\u00eau c\u1ee7a ph\u1eabu thu\u1eadt l\u00e0 tr\u1ea3 l\u1ea1i \u0111\u1ed9 v\u1eefng cho vai m\u00e0 \u00edt m\u1ea5t \u0111i bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng nh\u1ea5t. T\u1ea5t c\u1ea3 c\u00e1c th\u1ee7 thu\u1eadt vai \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh vai \u0111\u1ec1u li\u00ean quan \u0111\u1ebfn vi\u1ec7c m\u1ea5t chuy\u1ec3n \u0111\u1ed9ng. C\u00e1c ph\u1eabu thu\u1eadt hi\u1ec7n t\u1ea1i cho s\u1ef1 m\u1ea5t v\u1eefng c\u1ee7a vai tr\u01b0\u1edbc c\u1ed1 g\u1eafng kh\u00f4i ph\u1ee5c l\u1ea1i gi\u1ea3i ph\u1eabu b\u00ecnh th\u01b0\u1eddng m\u00e0 kh\u00f4ng l\u00e0m c\u0103ng d\u00e2y ch\u1eb1ng qu\u00e1 m\u1ee9c. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u1ea5t \u0111\u1ecbnh, ch\u1eb3ng h\u1ea1n nh\u01b0 \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i c\u00f3 nguy c\u01a1 t\u00e1i tr\u1eadt kh\u1edbp cao h\u01a1n v\u00e0 nh\u1eefng v\u1eadn \u0111\u1ed9ng vi\u00ean c\u00f3 k\u1ebf ho\u1ea1ch ti\u1ebfp t\u1ee5c tham gia c\u00e1c m\u00f4n th\u1ec3 thao khi\u1ebfn vai c\u1ee7a h\u1ecd g\u1eb7p r\u1ee7i ro, ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n sau l\u1ea7n tr\u1eadt kh\u1edbp \u0111\u1ea7u ti\u00ean. \u0110\u1ed1i v\u1edbi m\u1ea5t v\u1eefng ph\u00eda tr\u01b0\u1edbc ho\u1eb7c ph\u00eda sau do ch\u1ea5n th\u01b0\u01a1ng, b\u00e1c s\u0129 ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 t\u1ef1 tin th\u00f4ng b\u00e1o cho b\u1ec7nh nh\u00e2n c\u1ee7a m\u00ecnh r\u1eb1ng c\u01a1 h\u1ed9i tr\u1edf l\u1ea1i ch\u1ee9c n\u0103ng g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng c\u1ee7a h\u1ecd l\u00e0 l\u1edbn h\u01a1n 90%.<\/p>\n C\u00e1c th\u1ee7 thu\u1eadt \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ec3 ki\u1ec3m so\u00e1t s\u1ef1 m\u1ea5t v\u1eefng tr\u01b0\u1edbc c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u00f3m l\u1ea1i th\u00e0nh gi\u1ea3i ph\u1eabu v\u00e0 kh\u00f4ng gi\u1ea3i ph\u1eabu. Vi\u1ec7c kh\u00e2u ph\u1ee5c h\u1ed3i gi\u1ea3i ph\u1eabu bao g\u1ed3m vi\u1ec7c \u0111\u00ednh l\u1ea1i c\u00e1c c\u1ea5u tr\u00fac s\u1ee5n vi\u1ec1n bao kh\u1edbp v\u00e0o \u1ed5 ch\u1ea3o c\u0169ng nh\u01b0 thi\u1ebft l\u1eadp l\u1ea1i s\u1ee9c c\u0103ng th\u00edch h\u1ee3p trong bao kh\u1edbp v\u00e0 d\u00e2y ch\u1eb1ng. Bankart, Thomas v\u00e0 Matsen cho r\u1eb1ng ch\u1ec9 c\u1ea7n kh\u00e2u ph\u1ee5c h\u1ed3i s\u1ee5n vi\u1ec1n v\u00e0 bao kh\u1edbp d\u00ednh v\u00e0o n\u00f3 m\u00e0 kh\u00f4ng l\u00e0m ng\u1eafn c\u00e1c c\u1ea5u tr\u00fac d\u00e2y ch\u1eb1ng v\u00e0 bao kh\u1edbp ph\u00eda tr\u01b0\u1edbc. S\u1ef1 thu ng\u1eafn c\u1ee7a bao kh\u1edbp v\u00e0 c\u01a1 d\u01b0\u1edbi vai c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng khi kh\u00f4ng c\u00f3 v\u1ebft r\u00e1ch s\u1ee5n vi\u1ec1n, cho th\u1ea5y r\u1eb1ng bao kh\u1edbp d\u00e3n l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra s\u1ef1 m\u1ea5t v\u1eefng. Nh\u1eefng ng\u01b0\u1eddi kh\u00e1c m\u00f4 t\u1ea3 thu g\u1ecdn ph\u00eda trong c\u1ee7a bao kh\u1edbp ho\u1eb7c \u0111\u00ednh c\u01a1 d\u01b0\u1edbi vai nh\u01b0 m\u1ed9t ph\u1ea7n c\u1ee7a kh\u00e2u ph\u1ee5c h\u1ed3i Bankart. Wirth v\u00e0 c\u1ed9ng s\u1ef1 gi\u1ea3i th\u00edch r\u1eb1ng vi\u1ec7c gi\u1ea3m th\u1ec3 t\u00edch bao kh\u1edbp c\u0169ng quan tr\u1ecdng nh\u01b0 vi\u1ec7c s\u1eeda ch\u1eefa Bankart. Thu ng\u1eafn bao kh\u1edbp d\u01b0\u1edbi \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 m\u00f4 t\u1ea3 ban \u0111\u1ea7u c\u1ee7a Neer v\u00e0 Foster. S\u1ef1 thu ng\u1eafn bao kh\u1edbp tr\u01b0\u1edbc \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 gi\u1ea3m th\u1ec3 t\u00edch bao kh\u1edbp theo chu vi. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch r\u1ea1ch bao kh\u1edbp v\u00e0 tr\u01b0\u1ee3t c\u00e1c v\u1ea1t bao kh\u1edbp l\u00ean nhau \u0111\u1ec3 l\u00e0m c\u1ee9ng v\u00e0 gi\u1ea3m th\u1ec3 t\u00edch c\u1ee7a m\u00f4 bao kh\u1edbp xung quanh.<\/p>\n C\u00e1c quy tr\u00ecnh ph\u1eabu thu\u1eadt kh\u00f4ng gi\u1ea3i ph\u1eabu \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 h\u1ea1n ch\u1ebf s\u1ef1 xoay ngo\u00e0i v\u00e0 t\u1ea1o m\u1ed9t ch\u1ed7 d\u1ef1a ph\u00eda tr\u01b0\u1edbc \u0111\u1ec3 ch\u1ed1ng tr\u1eadt kh\u1edbp. Ch\u00fang bao g\u1ed3m th\u1ee7 thu\u1eadt Putti-Platt<\/a>, li\u00ean quan \u0111\u1ebfn vi\u1ec7c r\u00fat ng\u1eafn v\u00e0 n\u1ebfp g\u1ea5p c\u01a1 d\u01b0\u1edbi vai; th\u1ee7 thu\u1eadt Magnuson-Stack, l\u00e0 \u0111\u00ednh c\u01a1 d\u01b0\u1edbi vai; th\u1ee7 thu\u1eadt Eden-Hybbinette, \u0111\u00f3 l\u00e0 gh\u00e9p x\u01b0\u01a1ng m\u00e0o ch\u1eadu v\u00e0o tr\u01b0\u1edbc \u1ed5 ch\u1ea3o; v\u00e0 th\u1ee7 thu\u1eadt Bristow-Latarjet, l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh chuy\u1ec3n m\u1ecfm qu\u1ea1 v\u1edbi g\u00e2n li\u00ean k\u1ebft \u0111\u00ednh k\u00e8m \u0111\u1ebfn tr\u01b0\u1edbc d\u01b0\u1edbi \u1ed5 ch\u1ea3o xuy\u00ean qua ho\u1eb7c xung quanh c\u01a1 d\u01b0\u1edbi vai. C\u00e1c nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a k\u1ef9 thu\u1eadt m\u1edf bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng c\u01a1 d\u01b0\u1edbi vai, m\u1ea5t kh\u1ea3 n\u0103ng xoay ngo\u00e0i v\u00e0 kh\u00f3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ee9c m\u1ea1nh v\u00e0 tr\u1edf l\u1ea1i tham gia th\u1ec3 thao.<\/p>\n S\u1ef1 ra \u0111\u1eddi c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi kh\u1edbp \u0111\u00e3 mang \u0111\u1ebfn nh\u1eefng t\u00f2 m\u00f2 v\u00e0 th\u00e1ch th\u1ee9c m\u1edbi \u0111\u1ed1i v\u1edbi vi\u1ec7c x\u1eed tr\u00ed m\u1ea5t v\u1eefng ph\u00eda tr\u01b0\u1edbc c\u1ee7a kh\u1edbp vai. Ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi cho th\u1ea5y ch\u1ee9c n\u0103ng t\u1ed5ng th\u1ec3 t\u1ed1t h\u01a1n. Ph\u01b0\u01a1ng ph\u00e1p n\u1ed9i soi kh\u1edbp c\u00f3 m\u1ed9t s\u1ed1 \u01b0u \u0111i\u1ec3m so v\u1edbi ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn m\u1edf. N\u00f3 cho h\u00ecnh \u1ea3nh t\u1ed1t h\u01a1n v\u1ec1 b\u1ec7nh l\u00fd n\u1ed9i kh\u1edbp, h\u1ea1n ch\u1ebf b\u00f3c t\u00e1ch ph\u00f2ng ng\u1eeba s\u1ef1 \u0111\u1ee9t r\u00e1ch v\u00e0 kh\u00e2u ph\u1ee5c h\u1ed3i c\u01a1 d\u01b0\u1edbi vai, gi\u1ea3m s\u1eb9o v\u00e0 m\u1ea5t s\u1ee9c m\u1ea1nh sau ph\u1eabu thu\u1eadt, gi\u1ea3m th\u1eddi gian ph\u1ee5c h\u1ed3i, gi\u1ea3m m\u1ea5t bi\u00ean \u0111\u1ed9 v\u1eadn \u0111\u1ed9ng, gi\u1ea3m \u0111au v\u00e0 gi\u1ea3m ch\u1ea3y m\u00e1u sau ph\u1eabu thu\u1eadt. Ngo\u00e0i ra, th\u1ee7 thu\u1eadt c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf c\u01a1 s\u1edf ngo\u1ea1i tr\u00fa.<\/p>\n Kh\u00e2u ph\u1ee5c h\u1ed3i th\u00f4ng qua n\u1ed9i soi kh\u1edbp \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nhu c\u1ea7u cao (b\u1ec7nh nh\u00e2n tr\u1ebb tu\u1ed5i, nh\u1eefng ng\u01b0\u1eddi tham gia qu\u00e2n \u0111\u1ed9i, v\u1eadn \u0111\u1ed9ng vi\u00ean v\u00e0 n\u00e9m cao) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong c\u00e1c t\u00e0i li\u1ec7u g\u1ea7n \u0111\u00e2y. Tuy nhi\u00ean, trong m\u1ed9t nghi\u00ean c\u1ee9u so s\u00e1nh gi\u1eefa m\u1ed5 m\u1edf v\u00e0 n\u1ed9i soi kh\u1edbp \u1edf c\u00e1c v\u1eadn \u0111\u1ed9ng vi\u00ean, m\u1ed5 h\u1edf d\u1eabn \u0111\u1ebfn t\u1ec9 l\u1ec7 th\u1ea5t b\u1ea1i th\u1ea5p h\u01a1n.<\/p>\n N\u1ed9i soi th\u1ea5t b\u1ea1i li\u00ean quan \u0111\u1ebfn t\u1ed5n th\u01b0\u01a1ng Bankart dai d\u1eb3ng ho\u1eb7c t\u00e1i ph\u00e1t, t\u1ed5n th\u01b0\u01a1ng Hill \u2013 Sachs l\u1edbn, m\u1ea5t x\u01b0\u01a1ng \u1ed5 ch\u1ea3o, s\u1ed1 l\u1ea7n tr\u1eadt kh\u1edbp, s\u1ed1 l\u1ea7n ph\u1eabu thu\u1eadt ch\u1ec9nh s\u1eeda, t\u00ecnh tr\u1ea1ng l\u1ecfng l\u1ebbo kh\u1edbp \u0111\u1ed3ng th\u1eddi v\u00e0 th\u1eddi gian b\u1ea5t \u0111\u1ed9ng sau ph\u1eabu thu\u1eadt. M\u1ea5t x\u01b0\u01a1ng h\u01a1n 25% tr\u01b0\u1edbc d\u01b0\u1edbi \u1ed5 ch\u1ea3o, d\u00f9 do ti\u1ebfn tri\u1ec3n ho\u1eb7c m\u1eafc ph\u1ea3i, th\u01b0\u1eddng \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 s\u1eeda ch\u1eefa n\u1ed9i soi kh\u1edbp.<\/p>\n Giai \u0111o\u1ea1n I<\/strong>: t\u1eeb 0-4 tu\u1ea7n sau ph\u1eabu thu\u1eadt<\/p>\n + B\u1ea3o v\u1ec7 ph\u1ea7n s\u1ee5n s\u1eeda ch\u1eefa.<\/p>\n + Gi\u1ea3m vi\u00eam, gi\u1ea3m ph\u00f9 n\u1ec1.<\/p>\n + Cho ph\u00e9p v\u1eadn \u0111\u1ed9ng s\u1edbm tr\u00e1nh teo c\u01a1.<\/p>\n – Ch\u00fa \u00fd: \u0110eo n\u1eb9p b\u1ea3o v\u1ec7 kh\u1edbp vai trong v\u00f2ng 04 tu\u1ea7n, \u0111eo li\u00ean t\u1ee5c c\u1ea3 ng\u00e0y v\u00e0 \u0111\u00eam.<\/p>\n + Kh\u00f4ng v\u1eadn \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng v\u00e0 k\u00e9o d\u00e3n kh\u1edbp vai.<\/p>\n + Kh\u00f4ng ch\u1ee7 \u0111\u1ed9ng v\u1eadn \u0111\u1ed9ng c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00e1nh tay.<\/p>\n + Kh\u00f4ng ch\u1ea1y nh\u1ea3y.<\/p>\n + Kh\u00f4ng l\u00e0m c\u0103ng c\u01a1 tay trong v\u00f2ng 06 tu\u1ea7n.<\/p>\n – \u0110i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng trong 0 \u2013 2 tu\u1ea7n \u0111\u1ea7u sau ph\u1eabu thu\u1eadt:<\/p>\n + Ch\u01b0\u1eddm l\u1ea1nh kh\u1edbp vai 10 ph\u00fat\/c\u00e1ch 03 gi\u1edd \u0111\u1ec3 gi\u1ea3m s\u01b0ng n\u1ec1, gi\u1ea3m \u0111au.<\/p>\n + \u0110eo n\u1eb9p, ch\u01b0a v\u1eadn \u0111\u1ed9ng kh\u1edbp vai: v\u1eadn \u0111\u1ed9ng c\u1ed5 tay v\u00e0 b\u00e0n tay trong n\u1eb9p.<\/p>\n + \u0110eo n\u1eb9p v\u1edbi kh\u1edbp khu\u1ef7u<\/a> g\u1ea7n, cho ph\u00e9p v\u1eadn \u0111\u1ed9ng s\u1ea5p, ng\u1eeda khu\u1ef7u ch\u1ee7 \u0111\u1ed9ng v\u00e0i l\u1ea7n trong ng\u00e0y.<\/p>\n – Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng t\u1eeb 3 \u0111\u1ebfn 4 tu\u1ea7n sau m\u1ed5:<\/p>\n + Ti\u1ebfp t\u1ee5c ch\u01b0\u1eddm l\u1ea1nh kh\u1edbp vai<\/p>\n + T\u1eadp th\u1ee5 \u0111\u1ed9ng kh\u1edbp vai: cho ph\u00e9p d\u1ea1ng ngang vai th\u1ee5 \u0111\u1ed9ng, kh\u00e9p vai 80\u00b0<\/p>\n + Xoay ngo\u00e0i (xoay th\u1ee5 \u0111\u1ed9ng) t\u01b0 th\u1ebf trung gian, ti\u1ebfn d\u1ea7n \u0111\u1ebfn xoay ngo\u00e0i 30\u00b0<\/p>\n + T\u1eadp g\u1ed3ng c\u01a1 ch\u1ee7 \u0111\u1ed9ng trong n\u1eb9p ng\u00e0y v\u00e0i l\u1ea7n, t\u1eadp \u0111i b\u1ed9<\/p>\n + C\u00f3 th\u1ec3 ho\u1ea1t \u0111\u1ed9ng b\u00e0n ng\u00f3n tay v\u00ed d\u1ee5 nh\u01b0 s\u1eed d\u1ee5ng Computer n\u1ebfu ho\u1ea1t \u0111\u1ed9ng kh\u00f4ng g\u00e2y \u0111au kh\u1edbp vai.<\/p>\n Giai \u0111o\u1ea1n II<\/strong>: t\u1eeb 5-7 tu\u1ea7n sau ph\u1eabu thu\u1eadt<\/p>\n + T\u0103ng d\u1ea7n t\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp vai<\/p>\n + T\u1eadp m\u1ea1nh s\u1ee9c c\u01a1, gi\u1ea3m vi\u00eam, gi\u1ea3m ph\u00f9 n\u1ec1<\/p>\n + T\u0103ng c\u01b0\u1eddng ho\u1ea1t \u0111\u1ed9ng kh\u1edbp vai.<\/p>\n + Tr\u00e1nh xoay ngo\u00e0i kh\u1edbp vai qu\u00e1 m\u1ee9c.<\/p>\n + V\u1eadn \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng ch\u1ec9 khi b\u1ec7nh nh\u00e2n c\u00f3 ho\u1ea1t \u0111\u1ed9ng nh\u1ecbp nh\u00e0ng \u0111\u01b0\u1ee3c vai, c\u00e1nh tay.<\/p>\n + Kh\u00f4ng t\u1eadp s\u1ee9c c\u1ea3n c\u01a1 nh\u1ecb \u0111\u1ea7u c\u00e1nh tay trong v\u00f2ng 06 tu\u1ea7n<\/p>\n + Kh\u00f4ng \u0111\u01b0\u1ee3c n\u00e2ng v\u1eadt n\u1eb7ng, tr\u00e1nh c\u00e1c \u0111\u1ed9ng t\u00e1c \u0111\u01b0a l\u00ean qu\u00e1 \u0111\u1ea7u.<\/p>\n + C\u00e1c b\u00e0i t\u1eadp t\u0103ng d\u1ea7n t\u1eeb v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng \u0111\u1ebfn v\u1eadn \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng c\u00f3 tr\u1ee3 gi\u00fap v\u00e0 v\u1eadn \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng kh\u1edbp vai<\/p>\n + T\u1eadp g\u1ea5p vai \u1edf m\u1ee9c b\u1ec7nh nh\u00e2n ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c<\/p>\n + Kh\u00e9p d\u1ea1ng vai \u1edf m\u1ee9c ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c<\/p>\n + T\u1eadp xoay ngo\u00e0i 50\u00b0, xoay trong 60\u00b0, t\u1eeb v\u1ecb tr\u00ed g\u1ea5p khu\u1ef7u 90\u00ba.<\/p>\n Giai \u0111o\u1ea1n III<\/strong>: t\u1eeb 8-12 tu\u1ea7n sau ph\u1eabu thu\u1eadt<\/p>\n + B\u1ea3o v\u1ec7 v\u1ebft m\u1ed5<\/p>\n + L\u1ea5y l\u1ea1i h\u1ebft t\u1ea7m v\u1eadn \u0111\u1ed9ng kh\u1edbp vai<\/p>\n + T\u0103ng d\u1ea7n s\u1ee9c m\u1ea1nh c\u01a1<\/p>\n + T\u0103ng vai tr\u00f2 ki\u1ec3m so\u00e1t c\u01a1<\/p>\n + T\u0103ng vai tr\u00f2 ki\u1ec3m so\u00e1t th\u1ea7n kinh c\u01a1.<\/p>\n L\u00e0m m\u1ea1nh s\u1ee9c c\u01a1 nh\u1ecb \u0111\u1ea7u<\/p>\n + V\u1eadn \u0111\u1ed9ng g\u1ea5p 180\u00b0<\/p>\n + Xoay ngo\u00e0i kh\u1edbp vai 90\u00b0 t\u1eeb v\u1ecb tr\u00ed vai kh\u00e9p<\/p>\n + T\u1eadp kh\u1ecfe s\u1ee9c c\u01a1 \u0111ai vai.<\/p>\n + B\u00e0i t\u1eadp b\u00f2 t\u01b0\u1eddng<\/p>\n + Xoay trong vai ph\u00eda sau l\u01b0ng<\/p>\n + Xoay trong kh\u1edbp vai t\u1eeb v\u1ecb tr\u00ed vai g\u1ea5p 90\u00b0<\/p>\n + T\u1eadp c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y<\/p>\n + \u0110\u1ebfn 9 tu\u1ea7n: b\u1eaft \u0111\u1ea7u cho tay ra sau \u0111\u1ea7u t\u1eadp m\u1ea1nh s\u1ee9c c\u01a1 xoay trong, xoay ngo\u00e0i<\/p>\n + \u0110\u1ebfn 11 tu\u1ea7n: t\u1eadp c\u00e1c b\u00e0i t\u1eadp chuy\u1ec3n \u0111\u1ed9ng<\/p>\n + T\u1eadp nh\u1ecbp \u0111i\u1ec7u<\/p>\n + T\u1eadp c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y<\/p>\n + T\u1eadp c\u00e1c ho\u1ea1t \u0111\u1ed9ng vai tay.<\/p>\n Giai \u0111o\u1ea1n IV<\/strong>: t\u1eeb 12 – 16 tu\u1ea7n sau ph\u1eabu thu\u1eadt<\/p>\n + L\u1ea5y l\u1ea1i h\u1ebft t\u1ea7m v\u1eadn \u0111\u1ed9ng c\u1ee7a kh\u1edbp<\/p>\n + Ki\u1ec3m so\u00e1t c\u01a1 th\u1ea7n kinh<\/p>\n + Ki\u1ec3m so\u00e1t ch\u1ee9c n\u0103ng tay, s\u1eed d\u1ee5ng tay trong c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y.<\/p>\n B\u00c0I T\u1eacP: TI\u1ebeP T\u1ee4C DUY TR\u00cc C\u00c1C B\u00c0I T\u1eacP GIAI \u0110O\u1ea0N III<\/strong><\/p>\n + Duy tr\u00ec t\u1ea7m v\u1eadn \u0111\u1ed9ng ch\u1ee7 \u0111\u1ed9ng v\u00e0 th\u1ee5 \u0111\u1ed9ng kh\u1edbp vai<\/p>\n + Tr\u00e1nh tr\u1edf l\u1ea1i c\u00e1c ho\u1ea1t \u0111\u1ed9ng h\u00e0ng ng\u00e0y v\u00e0 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 thao g\u00e2y \u0111au kh\u1edbp vai<\/p>\n Giai \u0111o\u1ea1n V<\/strong>: t\u1eeb 16 – 24 tu\u1ea7n sau ph\u1eabu thu\u1eadt<\/p>\n Bi\u1ebfn ch\u1ee9ng d\u1ee5ng c\u1ee5<\/strong><\/p>\n Ph\u01b0\u01a1ng ph\u00e1p \u0111\u01a1n gi\u1ea3n nh\u1ea5t \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a d\u1ee5ng c\u1ee5 l\u00e0 ho\u00e0n to\u00e0n kh\u00f4ng s\u1eed d\u1ee5ng n\u00f3. Th\u1ea5t b\u1ea1i hay l\u1ecfng d\u1ee5ng c\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf v\u00e0i tu\u1ea7n ho\u1eb7c v\u00e0i n\u0103m sau ph\u1eabu thu\u1eadt.<\/p>\n Ph\u1ea3n \u1ee9ng sinh h\u1ecdc \u0111\u1ed1i v\u1edbi d\u1ee5ng c\u1ee5 c\u1ea5y gh\u00e9p: d\u1ee5ng c\u1ee5 h\u1ea5p th\u1ee5 \u0111\u01b0\u1ee3c \u00edt c\u00f3 ph\u1ea3n \u1ee9ng h\u01a1n v\u1eadt li\u1ec7u kim lo\u1ea1i. Tuy nhi\u00ean d\u1ee5ng c\u1ee5 h\u1ea5p th\u1ee5 \u0111\u01b0\u1ee3c c\u00f3 th\u1ec3 b\u1ecb x\u00f3i m\u00f2n do ph\u1ea3n \u1ee9ng sinh h\u1ecdc. N\u1ebfu ph\u1ea3n \u1ee9ng n\u00e0y qu\u00e1 m\u1ee9c, c\u00e1c t\u00e1c \u0111\u1ed9ng l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 x\u1ea3y ra. M\u1eb7c d\u00f9 ph\u1ea3n \u1ee9ng \u0111\u00e1ng k\u1ec3 h\u1ed7n h\u1ee3p v\u1edbi neo polyglyconat v\u00e0 acid polylactic kh\u00f4ng th\u01b0\u1eddng xuy\u00ean, n\u00f3 r\u00f5 r\u00e0ng c\u00f3 th\u1ec3 x\u1ea3y ra v\u00e0 nh\u00ecn th\u1ea5y v\u1edbi c\u00e1c v\u1eadt li\u1ec7u sinh h\u1ecdc kh\u00e1c, m\u1ee9c \u0111\u1ed9 c\u1ee7a ph\u1ea3n \u1ee9ng sinh h\u1ecdc t\u00f9y v\u00e0o v\u1eadt li\u1ec7u c\u1ee5 th\u1ec3.<\/p>\n Nhi\u1ec5m tr\u00f9ng<\/strong><\/p>\n Nhi\u1ec5m tr\u00f9ng l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng r\u1ea5t hi\u1ebfm g\u1eb7p sau ph\u1eabu thu\u1eadt m\u1ea5t v\u1eefng vai.<\/p>\n \u0110au<\/strong><\/p>\n \u0110au th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n sau khi ph\u1eabu thu\u1eadt m\u1ea5t v\u1eefng vai.<\/p>\n Bi\u1ebfn ch\u1ee9ng m\u1ed5 m\u1edf<\/strong><\/p>\n R\u00e1ch c\u01a1 d\u01b0\u1edbi vai sau khi s\u1eeda ch\u1eefa m\u1ea5t v\u1eefng ph\u00eda tr\u01b0\u1edbc ng\u00e0y c\u00e0ng \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra th\u1ea5t b\u1ea1i v\u00e0 th\u01b0\u01a1ng t\u1eadt sau ph\u1eabu thu\u1eadt.<\/p>\n![\"Gi\u1ea3i](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Giai-phau-o-chao-canh-tay-va-day-chang-300x282.png\" "\\"\\"")
![\"S\u1ee5n](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Sun-vien-o-chao-co-the-duoc-chia-thanh-6-vung-250x300.jpg\" "\\"\\"")
![\"Ph\u00e2n](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Phan-do-Snyder-cua-ton-thuong-SLAP-250x300.jpg\" "\\"\\"")
NGUY\u00caN NH\u00c2N<\/h3>\n
TRI\u1ec6U CH\u1ee8NG<\/h3>\n
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CH\u1ea8N \u0110O\u00c1N<\/h3>\n
\u0110I\u1ec0U TR\u1eca<\/h3>\n
PH\u1ee4C H\u1ed2I SAU M\u1ed4<\/h3>\n
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BI\u1ebeN CH\u1ee8NG SAU \u0110I\u1ec0U TR\u1eca PH\u1eaaU THU\u1eacT<\/h3>\n