Scapular Winging and Tilting의 치료

[문형철]

익상 견갑

- 어깨 굴곡에서 return할때 익상견갑/tilt가 개선됨

- medial border의 돌출

- 하각의 돌출

익상견갑

- GH 상승동안 익상견갑은 전거근 약화

- GH 하강동안 익상견갑은 axioscapular muscle들 만큼 scapulohumeral muscle이 늘어나지 못함. 

참고) Scapulohumeral muscles  

Deltoid muscle—This muscle forms a cap over the shoulder.  Its origin is on the anterior surface of the distal 1/3 of the clavicle, the acromion, and the spine of the scapula.  Its fibers extend distally and insert on the deltoid tuberosity of the humerus.  Its medial fibers act to abduct the upper limb (after abduction is initiated by the supraspinatus muscle).  The posterior fibers extend the shoulder while anterior fibers flex the shoulder.  The deltoid m. is innervated by the axillary nerve on its deep surface and its arterial supply is the posterior circumflex humeral artery. 

Teres Major muscle—This is a thick muscle with origin on the inferior angle of the scapula.  Its tendon goes medial to the humerus to insert on the crest of the lesser tubercle.  It acts as a medial rotator, extender, and adductor of the humerus.  It is innervated by a branch of the lower subscapular nerve (from the posterior cord of the brachial plexus).  Its arterial supply is from the supscapular artery. The teres minor assists the latissimus dorsi in its actions. 

Triceps brachii muscle (long head)—This muscle has its origin on the long head of the infraglenoid tubercle of the scapula.  We will discuss its details on

Thursday. 2The following four muscles are the rotator cuff muscles.  They completely encircle the humeral head and all have their origin on the scapula. 

Supraspinatus muscle—The origin of this muscle is the supraspinatus fossa of 

the scapula.  It inserts on the superior (highest) facet of the greater tubercle of the humerus.  Its action is to pull the humerus medially about 15º (to initiate 

abduction which is then taken over by the deltoid).  It is innervated by the 

suprascapular nerve and is supplied by the suprascapular artery.  This muscle is torn frequently. 

Infraspinatus muscle—The origin of this muscle is the infraspinatus muscle.  It inserts on the middle (inner) facet of the greater tubercle of the humerus.  It acts as a lateral rotator of the humerus with a range of motion of about 170º.  It is innervated and supplied by the suprascapular nerve and artery. 

Teres minor muscle—This muscle has its origin on the upper 2/3 of the lateral border of the scapula.  It inserts on the lowest facet of the greater tubercle of the humerus.  Its action is to laterally rotate the arm.  It is innervated by a branch of the axillary nerve and is supplied by the axillary artery and subscapular artery. 

Subscapularis muscle—This muscle’s origin on the medial 2/3 of the costal 

surface of the scapula (the subscapular fossa).  It covers the anterior glenoid fossa and inserts into the lesser tubercle of the humerus.  The muscle is innervated by the upper and lower subscapular nerves and is supplied by the subscapular artery.  It assists in extension and medial rotation of the arm. 

익상 견갑의 통증

- 충돌증후군, 흉곽출구증후군, 건염, 점액낭염, 회전근개 파열

익상견갑의 치료는 하부승모근의 근력, 근동원능력, 길이 교정

익상 견갑의 치료전략

- 하부승모근의 강화

- 소흉근의 스트레칭

- wall shoulder 굴곡

[고 인성]

익상 견갑의 치료전략
- 하부승모근의 강화
- 소흉근의 스트레칭
- wall shoulder 굴곡

[지여니]

죄송하지만... 왜 익상견갑치료를 할때 하부승모근의 강화를 해야하는 이유를 설명해주실수 있나요..?