"극상근"

[문형철]

어깨 석회화건염, 회전근개 파열의 주인공

1. 극상근은 어깨의 충돌현상의 희생양

2. 극상근 건은 poor vascularity 부위가 있어 석회화가 잘 일어나고, 극상근 건 퇴행화가 잘일어나 쉽게 파열.

3. 만약 극상근 건이 파열되면 어깨의 하방탈구가 일어남. 

4. 어깨외전 10-15도까지는 극상근 작용, 30~100도까지는 삼각근 중부섬유, 100도 외전이 넘어가면서 극상근이 다시 작용

5. 견갑와~상완골두 대결절에 부착

5. 

panic bird...

정리중...

)

The supraspinatus (plural supraspinati, from Latin supraspinatus) is a relatively small muscle of the upper back that runs from the supraspinatous fossa superior of the scapula (shoulder blade) to the greater tubercle of the humerus. It is one of the four rotator cuff muscles and also abducts the arm at the shoulder. The spine of the scapula separates the supraspinatus muscle from the infraspinatus muscle, which originates below the spine.

극상근의 구조

The supraspinatus muscle arises from the supraspinous fossa, a shallow depression in the body of the scapular above its spine. The supraspinatus muscle tendon passes laterally beneath the cover of the acromion. Research in 1996 showed that the postero-lateral origin was more lateral than classically described.^[1][2]

The supraspinatus tendon is inserted into the superior facel of the greater tubercle of the humerus.

• The distal attachments of the three rotator cuff muscles that insert into the greater tubercle of the humerus can be abbreviated as SIT when viewed from superior to inferior (supraspinatus, infraspinatus, and teres minor).

The acronym SITS regarding the rotator cuff muscles is completed by including the subscapularis muscle, which unlike the other rotator cuff muscles attaches to the lesser tubercle of the humerus.^[3]

극상근 신경지배

- 견갑상신경(Suprascapular nerve, C5-6)

극상근의 기능

Contraction of the supraspinatus muscle leads to abduction of the arm at the shoulder joint. It is the main agonist muscle for this movement during the first 10-15 degrees of its arc. Beyond 30 degrees the deltoid muscle becomes increasingly more effective at abducting the arm and becomes the main propagator of this action.

The supraspinatus muscle is one of the musculotendinous support structures called the rotator cuff that surround and enclose the shoulder. It helps to resist the inferior gravitational forces placed across the shoulder joint due to the downward pull from the weight of the upper limb.  The supraspinatus also helps to stabilize the shoulder joint by keeping the head of the humerus firmly pressed medially against the glenoid fossa[disambiguation needed] of the scapula.

- 극상근은 중력힘을 버티는 역할을 하고 있기 때문에 파열되면 견갑골 하방탈구가 될 수 있음.

Without a functioning supraspinatus, the physician must start abducting the patient's arm and eventually the patient will be able to finish abduction if the deltoid is functional, which is common because the supraspinatus is innervated by the suprascapular nerve from the superior/upper trunk of the brachial plexus. The deltoid is innervated more distally by the axillary nerve, which arises from the posterior cord of the brachial plexus.

Controversy about Action[edit]

A 1963 study, "Function of the Supraspinatus Muscle and its Relation to the Supraspinatus syndrome - An experimental in Man" by B Van Linge and J D Mulder in Leiden, Holland showed that the supraspinatus does not cause the abduction of the first 30 degrees, as widely accepted, but rather is a synergist muscle. This means that it assists the deltoid, but is not, by itself the abducting muscle. In this study, the supraspinatus was anaesthetised, and the deltoid muscle was still able to complete a full range of abduction, however was not able to sustain an isometric contraction for more than one minute. From this study, it is suggested that the "true" action of the supraspinatus is to hold the capsule in position to allow greater functional strength and stamina of the deltoid muscle.^[4]

In support of this study, one should also consider the basic mechanics of the forces involved in abduction of the shoulder. Supraspinatus is a smaller and weaker muscle compared to deltoid on three counts: deltoid has three large components - anterior, middle and posterior fibre groups; secondly the middle fibres have a multipennate arrangement believed to pack more muscle power into a relatively compact space;^[5] thirdly it attaches to the deltoid tuberosity half way down the humerus adding to the mechanical advantage to abduct the arm. Thus the bulk, arrangement and insertion of the deltoid fibres are designed for the power needed to overcome the load of the weight of the arm plus any load in the hand. By contrast, supraspinatus is a much smaller muscle with convergent fibres leading to a tendon which attaches on the highest facet on the greater tubersosity of the humerus, thereby affording it minimal traction on the arm. The arm is a very long lever with the added weight of muscles and other soft tissues.If supraspinatus were capable of initiating abduction it would not only need the power to move a heavy lever but would need to overcome the intertia offered by the stationary limb. Sharkey et al (1994)^[6] identified that the whole of the rotator cuff group contributes to abduction of the arm, reducing the work of deltoid by 41%.It strongly suggests that the rotator cuff act synergically in concert with deltoid to stabilise the head of the humerus whilst deltoid provides the turning moment at the gleno-humeral joint to abduct the arm. Indeed if deltoid is palpated when abduction is initiated, active contraction of the muscle can be detected suggesting co-contraction of deltoid with the rotator cuff rather than after initiation by any of the rotator cuff muscles.

극상근의 Poor vascularity 부위

극상근의 석회화

극상근의 Trp 탐구

- 극상근 Trp는 팔꿈치로 연관통 유발함. 

극상근 건 촉진법

열중쉬어 자세를 취하면 견봉하점액낭이 뒤로 빠져나가면서  극상근 건이 정확하게 드러남.

극상근 추나건 SVT방법

에반스 스트레칭

thera band를 이용한 극상근 isolated exercise

 

[정기홍]

삼차원 동영상 등 극상근의 모든 것이 모였네. 귀한 자료 고마워~!

[문형철]

응.. 아직 다 안끝났어.. 더 왅전한 폼으로 정리한 후에 유튜브동영상 만들라고

[tommyjung]

이런 isolated exercise 는 위험한 운동이라고 생각합니다.
shoulder IR 된 상태로 외전되면 당연히 안 일어나던 impinge가 더 심해지는데,
안그래도 아파서 온 사람들은 더 손상이 오겠죠. 더군다나 thoracic position 교육없이 한다면 더 심하겠지요.

이 동영상은 그냥 참고만 해야 합니다. 정말 가급적 시행해서는 안됩니다. 이런것이 있는 정도...로.

[야 여름이다]

재활시 극상근 운동은 어떤게 좋은가요??

[문형철]

맨 아래 동영상이 극상근 운동입니다 ㅎㅎ

[야 여름이다]

앗^^ 선생님 감사합니다.