Ludewig P M, Cook T M
Program in Physical Therapy, Department of Physical Medicine and Rehabilitation, Box 388 Mayo, 420 Delaware St, University of Minnesota, Minneapolis, MN 55455, USA.
Phys Ther. 2000 Mar;80(3):276-91.
Treatment of patients with impingement symptoms commonly includes exercises intended to restore "normal" movement patterns. Evidence that indicates the existence of abnormal patterns in people with shoulder pain is limited. The purpose of this investigation was to analyze glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work.
Fifty-two subjects were recruited from a population of construction workers with routine exposure to overhead work.
Surface electromyographic data were collected from the upper and lower parts of the trapezius muscle and from the serratus anterior muscle. Electromagnetic sensors simultaneously tracked 3-dimensional motion of the trunk, scapula, and humerus during humeral elevation in the scapular plane in 3 handheld load conditions: (1) no load, (2) 2. 3-kg load, and (3) 4.6-kg load. An analysis of variance model was used to test for group and load effects for 3 phases of motion (31(-60(, 61(-90(, and 91(-120().
Relative to the group without impingement, the group with impingement showed decreased scapular upward rotation at the end of the first of the 3 phases of interest, increased anterior tipping at the end of the third phase of interest, and increased scapular medial rotation under the load conditions. At the same time, upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement in the final 2 phases, although the upper trapezius muscle changes were apparent only during the 4.6-kg load condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads and phases.
Scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function are important to consider in the rehabilitation of patients with symptoms of shoulder impingement related to occupational exposure to overhead work. [Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.
对有撞击症状的患者进行治疗时，通常会采用旨在恢复“正常”运动模式的锻炼方法。表明肩痛患者存在异常模式的证据有限。本研究的目的是分析一组有肩部撞击症状的受试者相对于一组在职业性从事头顶上方工作方面相匹配的无肩部撞击症状受试者的盂肱关节和肩胛胸壁关节的运动学以及相关的肩胛胸壁肌肉活动。
从经常从事头顶上方工作的建筑工人人群中招募了52名受试者。
从斜方肌的上部和下部以及前锯肌采集表面肌电图数据。在三种手持负荷条件下，即（1）无负荷、（2）2.3千克负荷和（3）4.6千克负荷时，电磁传感器在肩胛平面内肱骨抬高过程中同时跟踪躯干、肩胛骨和肱骨的三维运动。采用方差分析模型对三个运动阶段（31°至60°、61°至90°和91°至120°）的组间和负荷效应进行检验。
与无撞击组相比，撞击组在感兴趣的三个阶段中的第一个阶段结束时肩胛骨上旋减少，在第三个阶段结束时前倾角增加，并且在负荷条件下肩胛骨内旋增加。同时，与无撞击组相比，撞击组斜方肌上部和下部的肌电图活动在最后两个阶段增加，尽管斜方肌上部的变化仅在4.6千克负荷条件下明显。在所有负荷和阶段中，撞击组的前锯肌活动均降低。
在对与职业性头顶上方工作相关的肩部撞击症状患者进行康复治疗时，肩胛骨倾斜（绕内侧至外侧轴的旋转）和前锯肌功能是需要考虑的重要因素。[Ludewig PM, Cook TM. 肩部撞击症状患者的肩部运动学改变及相关肌肉活动。
