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MUDr. Alois Krobot, Ph.D.Klinika rehabilitace FN a LF UP
Olomouc
REHABILITATION
IN THE SHOULDER MUSCULOSKELETAL PATHOLOGY
Krobot : ČB : 13. 4. 2007 2
PAIN SHOULDER SYNDROMES
ONLY THREE CATEGORIES OF THE PEOPLE EXIST:
1) They have had
2) They have
3) They will have
ANY PAIN AND DYSFUNCTION OF THE SHOULDER
Krobot : ČB : 13. 4. 2007 3
PAIN SHOULDER DYSFUNCTION
REHABILITATION / MANUAL THERAPY / PHYSIOTHERAPY
CONCEPTS
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FUNDAMENTAL THESES
1) MYOFASCIAL TISSUES2) FUNCTIONAL DISORDERS
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CORE PROBLEM: FUNCTIONAL MIND
FUNCTIONAL (PRAGMATIC) RHC STRATEGY
RECENT TREND: � RHC = PREVENTIVE CARE
� AND THE SAME TIME
� RHC = EARLY - STRUCTURED - GOAL DIRECTED INTERVENTION
� 1) FUNCTIONAL (MOVEMENT) DIAGNOSTICS� 2) FUNKCTIONAL (MANUAL) THERAPY
� CORE PROBLEM:
� EARLY (!) AND SPECIFIC (!) RHC INTERVENTION DEMANDS ATTENTION TO VERY SUBTITLE CLINIC SYMPTOMS
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� OPTIMAL FUNCTION OF THE MOTOR UNITS � (ONE MUSCLE)
� OPTIMAL FUNCTIONAL CO-ACTIVATION� (ALL MUSCLES : GIRDLE / BODY)
FUNCTIONAL BASIS IN REHABILITATION
CORNER STONE OF THE MODERN RHC� OPTIMAL FUNCTION OF THE MUSCLES
� (IT HAS 2 DIMENSIONS)
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MAIN GOAL: OPTIMAL FUNCTIONAL CO-ACTIVATION GIRDLE MUSCLE WITH IN TERMS OF ALL BODY MUSCLES)
FUNCTIONAL BASIS IN REHABILITATION
OPTIMAL FUNCTION OF THE MUSCLES (2. DIMENSION)
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4P:
� (P)rotectors (glenohumeral) � rotator cuff muscles
� (P)ivotors (scapulohumeral)� scapular rotator muscles
� (P)ositioners (humeral)� all parts of the deltoid� mBiBr + mTrBr (c.lg.)
� (P)ower – driwers� mPectMjr + mLD
FUNCTIONAL BASIS IN REHABILITATION
FUNCTIONAL CATEGORIZATION OF THE SHOULDER MUSCLES(Basmaian, 1968; DeLuca 1989; Townsend, 1991; Moseley, 1992)
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ROLE OF THE GIRDLE MUSCLES: NOT ONLY MOVEMENTS OF ARM and HAND
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GIRDLE MUSCLES: COMPLICITY IN VENTILATION AND POSTURAL TASKS
“UPPER EXTREMITIES MOVEMENTS“ (UEM)COMPLICITY GIRDLE MUSCLES IN ALL POSTURAL TASKS
(Enoca, 1999; Creswell,2000; Gandevia, 2005)
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GIRDLE MUSCLES: COMPLICITY IN VENTILATION AND POSTURAL TASKS
antDelt dxantDelt sin__
postDelt dxpostDelt sin__mBiBr dxmBiBr sin__mTrBr dxmTrBr sin__mLD dxmLD sin__mReFe dxmReFe sin
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GIRDLE MUSCLES: COMPLICITY IN VENTILATION AND POSTURAL TASKS
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SHOULDER PAIN : ENTRAPMENT SYNDROMES
� quadrilateral space sy (Cahill, 1983)
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SHOULDER PAIN : ENTRAPMENT SYNDROMES
� quadrilateral space sy� hypothetical patogenesis
USG (Dopler) argumentation(Krobot, Vomáčka 2000)
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QUADRILATERAL SPACE SYNDROME : USG
Dopler argumentation : Poor effect Elevation+ExRotation of the
humerus in indisposed patient (Krobot, Vomáčka 2000)
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QUADRILATERAL SPACE SY: THERAPY
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COSTO – CLAVICULAR SPACE SYNDROME
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COSTO – CLAVICULAR SPACE SYNDROME
Trendelenburg test evidens more than „insufficiency abductors“
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COSTO – CLAVICULAR SPACE SYNDROME
Trendelenburg test evidens more than „insufficiency abductors“
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COSTO – CLAVICULAR SPACE SYNDROME
Trendelenburg test evidens more than „insufficiency abductors“
(Krobot, Míková, 2000)
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COSTO – CLAVICULAR SPACE SYNDROME
ONE FORM OF THE THERAPY
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SHOULDER PAIN SYNDROMES : mLD
Frequent cause : STRAIN SY mLD
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SHOULDER PAIN SYNDROMES : mLD
STRAIN SY mLD : (SELF) PHYSIOTHERAPY
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SHOULDER PAIN SYNDROMES :MORFOGENETIC VARIATIONES
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2) Variation in the shape of the human scapula - „antropometric standard“ (Hrdlicka A, 1942)
SHOULDER PAIN SYNDROMES :MORFOGENETIC VARIATIONES
1) Variations in human acromial posture:FLAT / SMOOTH CURVE / ANTERIOR HOOK
(Bigliani, et all, 1983)
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FUNCTIONAL CATEGORIZATION: SHAPE´S VARIATIONES OF SCAPULA
� STATISTICAL COMPARISON 3 METHODS� ANTROPOMETRY� DYNAMOMETRY
� RADIOLOGY� 322 healthy probands� 189 msm patients
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shape (0) shape (1) shape (2)
FUNCTIONAL CATEGORIZATION: SHAPE´S VARIATIONES OF SCAPULA
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shape (3) shape (4) shape (5)
FUNCTIONAL CATEGORIZATION: SHAPE´S VARIATIONES OF SCAPULA
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Tvar lopatkyFrekv. [%]
Vy_sc [cm]
In_sc [%]
Uh_sc [st]
Výkon [N]
Označení
20 %ž < 8 cm
m < 9 cm
< 75 % < 70 st.
ž< 7 N
m<8 N
adolescentní
15-20 %
ž = 8-9 cm
m = 9-11cm
75 – 85 %
70 - 80 st.
ž=6-9 N
m=8-11 N
astenický
35%
Ž = 9-11 cm
m=11-13 cm
85 – 95 %
80 - 90 st.
ž= 9-12 Nm=10-
15N
standartní
(ženský)
15-20%
Ž=11-14cmm=12-15cm
90 –100%
90 – 100 st.
ž> 12 N
m>15 N
standartní
(mužský)
10%
ž > 14 cm
m=14-20cm
> 105 % > 100 st.
ž>14 N
m>30 N
atletický
FUNCTIONAL CATEGORIZATION: SHAPE´S VARIATIONES OF SCAPULA
Shape´s variationes of thefossa infraspinata
1) area fossa infraspinataand
2) length of mInfraSp
proximity
-strenght and (!) first of allthe velocity of the contraction
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Functional categorization of the individual morphology of the scapula ?
� postural position and invidual morphology of the scapula� context
� (subtle) postural disorders� occasion
� many musculoskeletal syndromes
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REHABILITATION OF SHOULDER MUSCULOSKELETAL SYNDROMES
� PREVENTION� ATTENTION FUNCTIONAL (SUBTLE) SYMPTOMS� (NO ONLY MOVEMENT OF GLENOHUMERAL JOINT
� MANUAL THERAPY� KNOW-HOW
� STRETCH OF THE PERIMYSIUM /NOT PROPER MUSCLE
� REFLEX MANUAL THERAPY
� EDUCATION OF NEUROMUSCULAR STABILIZATION
� REHABILITATION EXCERCISE PROGRAMME� GOAL
� CO-ACTIVATION MUSCLES FOR STABILIZATION
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REHABILITATION PROGRAMME: CO-ACTIVATION MUSCLES FOR STABILIZATION
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RECENT REHABILITATION FORMS:SPECIFIC FUSION: 1)REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
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RECENT REHABILITATION FORMS: FUSION :1) REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
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012345678
násobky aktiva ční hodnoty
SCMl.sin.
SCMl.dx.
TBl.sin.
TBl.dx.
BBl.sin.
BBl.dx.
LDl.sin.
LDl.dx.
Porovnání aktivace sval ů ABD+ZR LHK
příjem propuštění
RECENT REHABILITATION FORMS: FUSION :1) REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
Krobot : ČB : 13. 4. 2007 36
Porovnání aktiva čních hodnot
0
5
10
15
20
25
30
prijem blok propusteni
uVSCM l.sin. µV
SCM l.dx. µV
TB l.sin. µV
TB l.dx. µV
BB l.sin. µV
BB l.dx. µV
LD l.sin. µV
LD l.dx. µV
RECENT REHABILITATION FORMS: FUSION :1) REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
Krobot : ČB : 13. 4. 2007 37
0
1
2
3
45
6
7
násobky aktiva čních
hodnot
SCMl.sin.
SCMl.dx.
TBl.sin.
TBl.dx.
BBl.sin.
BBl.dx.
LDl.sin.
LDl.dx.
TD na LDK
příjem blok propuštění
0
1
2
3
4
5
násobky aktiva čních
hodnot
SCMl.sin.
SCMl.dx.
TBl.sin.
TBl.dx.
BBl.sin.
BBl.dx.
LDl.sin.
LDl.dx.
TD na PDK
příjem blok propuštění
Krobot : ČB : 13. 4. 2007 38
GENERAL DRIFT OF RECENT REHABILITATION PROGRAMMES
RECOVERY : RECOVERY : COMPREHENSIVE COMPREHENSIVE
PHYSIOLOGICAL PHYSIOLOGICAL MUSCLEMUSCLE´́S FUNCIONS FUNCION
