견갑하근

[문형철]

흔히 통증이 발생, 견갑골아래 숨어있어서 치료에서 소외되는 근육

1. 견갑하근은 상완이두근, 횡인대와 연결되어 있기 때문에 견갑하근 건염이 상완이두근 건염으로 흔히 오인

2. 또한 견갑하근은 견갑골아래에 숨어 있으면서도 움직임이 많기 때문에 흔히 통증이 발생..

3. 잘 낫지 않는 어깨통증일때 반드시 고려해야 하는 근육이다.

4. Lift off test로 견갑하근 검사함.

5. 견갑하근 Trp로 손목에 연관통 발생

바쁘면 2분-2분20초 분량만 보면됨. 

panic bird..

)

The subscapularis is a large triangular muscle which fills the subscapular fossa and inserts into the lesser tubercle of the humerus and the front of the capsule of the shoulder-joint.

It arises from its medial two-thirds and from the lower two-thirds of the groove on the axillary border (subscapular fossa) of the scapula.

Some fibers arise from tendinous laminae which intersect the muscle and are attached to ridges on the bone; others from an aponeurosis, which separates the muscle from the teres majorand the long head of the triceps brachii.

The fibers pass laterally and coalesce into a tendon which inserts into the lesser tubercle of the humerus and the anterior part of the shoulder-joint capsule.

견갑하근 신경지배

Innervation to subscapularis is supplied by the upper and lower subscapular nerves, branches of the posterior cord of the brachial plexus. (C5-C7)

견갑하근 기능

The subscapularis rotates the head of the humerus medially (internal rotation); when the arm is raised, it draws the humerus forward and downward. It is a powerful defense to the front of theshoulder-joint, preventing displacement of the head of the humerus.

Examination[edit]

The Gerber Lift-off test is the established clinical test for examination of the subscapularis. The bear hug test (internal rotation while palm is held on opposite shoulder and elbow is held in a position of maximal anterior translation) for subscapularis muscle tears has high sensitivity. Positive bear-hug and belly press tests indicate significant tearing of subscapularis.^[1]

Imaging[edit]

MRI. Partial rupture of the cranial subscapularis tendon at the insertion site.

Although the subscapularis is the major and most powerful muscle of the rotator cuff and has an enormous meaning in the gleno-humeral stability and dynamic it is neglected in the clinical literature. Despite its importance and impact on conservative or surgical treatment, operative planning and approach or post-surgical prognosis. Lo and Burkhart even tagged the subscapularis tendon hypercritically as the "forgotten tendon". That arises by the gap of the described tear preval‎ence in cadavers between 29 and 37% and in clinical studies around 27%. This is likely related to the difficulties in radiological, arthroscopic and even open surgical assessment of this particular muscle and its tendon, especially for inferior tears. For example can even full-thickness tears be mimicked by intact tendon fibers or overlying scars attached to the greater tuberosity. Since the strong stabilizing effect of the coraco-humeral ligament a possible muscle retraction can be expeditiously underestimated. Scar tissue can be adulterant for MR Arthrographic images, as it may prevent leakage of contrast material.
There is no singularly imaging device or technique for a satisfying and complete subscapularis examination, but rather the combination of the sagittal oblique MRI / short-axis US and axial MRI / long-axis US planes seems to generate useful results. Additionally lesser tuberosity bony changes have been associated with subscapularis tendon tears. Findings with cysts seem to be more specific and combined findings with cortical irregularities more sensitive.^[2]

Another fact typically for the subscapularis muscle is the fatty infiltration of the superior portions, while sparing the inferior portions.

Since the long biceps tendon absents itself from the shoulder joint through the rotator cuff interval it is easily possible to distinguish between the supraspinatus and the subscapularis tendon. Those two tendons build the interval sling.

Ultrasonography[edit]

Mack et al. developed an ultrasonographic procedure with which it is possible to explore almost the complete rotator cuff within six steps. It unveils clearly the whole area from the subedge of the subscapularis tendon until the intersection between infraspinatus tendon and musculus teres minor. One of six steps does focus on the subscapularis tendon. In the first instance the examinator guides the applicator to the proximal humerus as perpendicularly as possible to the sulcus intertubercularis. Gliding now medially shows the insertion of the subscapularis tendon.^[3]

Longitudinal plane of the musculus subscapularis and its tendon The subscapularis tendon lies approximately 3 to 5 centimeter under the surface. Quite deep for ultrasonogaphy, and therefore displaying through a highly penetrative 5 MHz linear applicator is worth a try. And it really turned out to ease a detailed examination of the muscle which just abuts to the scapula. However, the so primarily interested tendon does not get mapped as closely as desired. As anatomical analysis showed, it is only by external rotation possible to see the ventral part of the joint socket and its labrum. While at the neutral position the tuberculum minus occludes the view. Summing up it is through an external arm rotation and a medially applied 5 MHz sector sonic head possible to display the ventral part of the joint socket and its labrum with notedly lower echogenicity.^[4]

The following sectional planes are defined for the sonographic examination of the different shoulder joint structures:^[5]

견갑하근 스트레칭

견갑하근 wall stretching

견갑하근 건 촉진법

견갑하근 Trp 탐구

- 손목으로 연관통 발생

MRI진단

- 필요하다면 초음파진단법도 소개해야겠구나!!

에반스의 견갑하근 isolated stretching

[heoss]

감사합니다.

[곰두리75]

감사합니다.^^

[궁금증해결]

감사합니다.

[김다운]

insertion - humerus의 lesser tubercle, the shoulder-joint capsule의 앞부분
신경지배 - upper and lower subscapular nerves, (brachial plexus. (C5-C7))
기능 internal rotation, preventing displacement of the head of the humerus.

저도 지금 어깨가 아픈데 lift off 테스트시 근력이 오른쪽에 비해 왼쪽이 많이 약해져 있습니다.
trp 그림 보니까 저도 팔꿈치 윗부분으로 많이 아팠는데...(그게 뭐 딱 이근육 때문인건 아니겠지만.) 손목이 아프지는 않았습니다. 그때 아팠으면 이그림보고 재밌었을텐데.
다른 근육도 한번 테스트 해봐야겠네요. 운동법이있어서 참 좋습니다. 감사합니다.