Transcript 상완골의 운동손상 증후군 제출용x

Ideal alignment of the body segments
facilitated
Ideal movement
Movement patterns + alignments
Several combinations
Humeral alignment - correct
but movement - impaired.
• EX) The humerus is correctly positioned at rest,
• but during shoulder flexion the humerus medially rotates
excessively.
Humeral alignment - Impaired, and normal range
but does not correct or compensate for the initial impaired position.
• EX) The humerus is medially rotated in the standing position and
laterally rotates during abduction but not enough to correct for
the impaired starting
Humeral alignment - Impaired
and movement patterns - Impaired.
• EX) The humerus is medially rotated in the standing position and
does not rotate during abduction.
movement impairment of the
humeral head on the
glenoid.
• 환자가 상완골의 운동
손상을 교정하거나 능
동 운동을 실시하는 동
안
치료사가 손으로 손상
을 교정하면 증상이 감
소되거나 없어진다.
Ex) The therapist assists in
lateral rotation of the
humerus during the
appropriate range of
shoulder flexion
decreased pain
Ex) Humeral anterior glide
during shoulder
hyperextension as occurs
during arm swing when
walking
Ex) Humerus positioned in
medial rotation and
failing to rotate laterally
during shoulder
abduction.
• 상완골 전방활주 (humeral anterior glide)
• 상완골 상방활주 (humeral superior glide)
• 견관절 내회전 (shoulder medial rotation)
• 상완견관절 저운동성 (glenohumeral
hypomobility)
• Pain
– Anterior or anteriomedial aspect of the shoulder joint
– Along the proximal one third of the biceps brachii
tendon
– Manual resistance to elbow flexion, shoulder abduction
performed with the elbow flexed/ glenohumeral joint
laterally rotated
• Pain increase
– Glenohumeral medial rotation
– Shoulder hyperextension, horizontal abduction, flexion
(esp. 80~180degree)
• Symptoms
– Like bicipital tendinopathy, early stages of
impingement syndrome (supraspinatus
tendinopathy & bursitis)
• Anterior dislocation can occur if the anterior
joint capsule has been weakened
• Excessive anterior motion of the
humeral head into the anterior joint
capsule
–
–
–
–
Glenohumeral abduction
Initiation of glenohumeral flexion
Return from the end range of flexion (elevation)
Glenohumeral joint rotation with the shoulder
in 90 degrees of abduction
• More than one third of the humeral head is
anterior to the acromial process of the
scapula
• The humeral head is more anterior than the
distal humerus
• The humerus is forward of the acromion in
addition to the anterior tilt of the scapula
• On the posterior surface, there is a slight
indentation below the acromion
• The anterior joint capsule is
more flexible than the posterior
capsule and the glenohumeral
lateral rotators
• Recruitment patterns
– The action of the pectoralis major muscle as
a medial rotator of the glenohumeral joint is
more dominant than the action of the
subscapuralis muscle
– The infraspinatus & teres minor muscles are
recruited more strongly than the
subscapularis muscle when acting as
depressors of the humerus
Muscle length & strength
impairments
-The lengthened or weak subscapularis
muscle
: the anterior glide of the humeral
head
-Shortness of the scapulohumeral
lateral rotators
•
A. Normal shoulder flexion
•
B. Shortness of posterior joint
capsule, so shoulder flexion
result in humeral head
upwardly
: Stiffness of the posterior capsule
Preventing posterior glide of the
humeral head
Shortness of the pectoralis major muscle
•
•
•
•
Medial rotation of the humerus
the anterior position of the humeral head
Abducted position of the scapula
Increased anterior glide of the humerus during
shoulder lateral rotation & horizontal abduction
• Prevents the anterior glide of the
humeral head during shoulder
rotation & flexion
Decreases the symptoms
• Correct the anterior
position of the humeral
head at rest
• Prevent the anterior glide
during motion
• Shorten and strengthen
the subscapularis
• Stiffness or shortness of
the humeral lateral rotators
must be corrected to
enable the humeral head
to glide posteriorly
• Shortness of the pectoralis
major muscle should be
stretched
• Exercise improves the passive range into
– Medial rotation (supine)
– Horizontal adduction (supine; standing against a wall)
– Flexion (standing facing a wall)
• Exercise to strengthen the subscapularis
– Medial rotation (Lying on a table or bed in the prone position)
• Exercise to humeral head posterior glide
– Flexion (quadruped position, standing)
• Assist in reducing the stress on the anterior joint
capsule
– Taping (force to pull the humeral head posteriorly)
• Correcting scapular alignment
– Forward or depressed position
• 전방 관절낭에 스트레스 감소를 보조하기
위한 다른 치료는 상완골두가 후방으로 당
겨지는 힘을 제공하도록 견관절 앞쪽에 테
이핑을 하는 것이다.
• 종종 전방, 하강 자세로 되어 있는 견갑골
정렬을 교정하는 것이 필요
감사합니다^^