Dynamic evaluation and early management of altered motor control around the shoulder complex -반드시 정리해야

[문형철]

 모든 근골격계의 검사는 동적인 상태에서의 테스트가 중요하다. 

shoulder complex의 동적 검사법에 관한 논문이다.

movement assessment

movement therapy

인체 스스로 치유할 수 있는 가장 기본적인 원리요. 

의료인으로서 나의 궁극적인 꿈이다.

panic bird...

Dynamic eval‎uation and early management of altered motor co.pdf

Altered dynamic control appears to be a significant contributing factor to shoulder dysfunction. The shoulder relies primarily on the rotator cuff for dynamic stability through mid-range. Hence, any impairment in the dynamic stabilizing system is likely to have profound effects on the shoulder complex. The rotator cuff appears to function as a deep stabilizer, similar to the transversus abdominus and vastus medialis obliquus, with some evidence of disruption to its stabilizing function in the presence of pain. 

Similarly, serratus anterior appears to function as a dynamic stabilizer, also demonstrating altered function in painful shoulders. Examination of dynamic control begins with a detailed examination of posture, eval‎uation of natural movement patterns and functional movements and assessment of the specific force couples relevant to shoulder function. One useful strategy in management of altered motor control related to these force couples is that of training isolated contraction of the rotator cuff prior to introduction of loaded activity, together with facilitation and training of appropriate scapular muscle force couples – serratus anterior and trapezius, in relation to arm elevation. 

Fig. 2—Force couples around the scapula relevant in arm elevation (Adapted from Bagg and Forrest 1986; Kapandji 1982). Depicted is the most common pattern of muscle recruitment reported by Bagg and Forrest (1986). 

(A) In the first 60도, the axis of rotation of the scapula is situated at the root of the spine of the scapula. Primary muscles involved in upward rotation of the scapula are lower fibres of serratus anterior and upper trapezius, working via the clavicle, with lower and middle trapezius functioning eccentrically to control the movement. In this range, muscle function is highly variable. 

(B) In the next 60도, the axis of rotation begins to move along the spine of the scapula towards the acromioclavicular joint. This means that the emphasis of contribution of the muscles changes, with the fibres of lower trapezius now becoming more actively involved in upward rotation, along with those of lower serratus anterior and upper trapezius. 

(C) By the time the arm reaches 120도 of elevation, the axis of rotation is at the acromioclavicular joint. Upper trapezius is no longer positioned to be able to function to upwardly rotate the scapula, whereas lower trapezius is now ideally situated to perform this function, in conjunction with lower serratus anterior. 

(D) In the final stages of elevation, lower trapezius and lower serratus anterior are the primary rotators of the scapula, with upper trapezius functioning to rotate the clavicle and middle trapezius working eccentrically to control the degree of upward rotation.

[heoss]

감사합니다.^^