Alexander C M
Department of Physiotherapy, Hammersmith Hospitals NHS Trust, London, UK.
Clin Neurophysiol. 2007 Dec;118(12):2664-71. doi: 10.1016/j.clinph.2007.09.057. Epub 2007 Oct 18.
Reflexes of shoulder girdle muscles such as trapezius are evoked from muscle afferents supplying the forearm and hand in healthy subjects. These reflexes are thought to aid the stability of the shoulder during use of the arm and hand [Alexander CM, Harrison PJ. Reflex connections from forearm and hand afferents to shoulder girdle muscles in humans. Exp Brain Res 2003;148: 277-282.]. With this in mind, the objective of this investigation was to examine this trapezius reflex in subjects with non-traumatic shoulder instability (NTSI).
The occurrence and alteration to this supraspinal reflex pathway were investigated using electrical stimulation of the ulnar and the spinal accessory nerves as well as magnetic stimulation of the trapezius motor cortex. These results were compared to a healthy group.
The reflexes to lower trapezius were not usually observed in subjects with NTSI. When evoked, the frequency of occurrence was 27% compared to 87% in a healthy population (p<0.002). When present, the latency of this lower trapezius reflex was later than that evoked in the healthy group (62.8 ms+/-28.1 ms and 38.4 ms+/-3.6 ms, respectively; p<0.009). Although both the conduction velocity of the effective afferents and the latency of the M response to lower trapezius did not differ to the healthy group (p<0.24 and 0.54, respectively), the latency and threshold of the corticospinal evoked potential of lower trapezius did differ (16.7 ms+/-4.7 ms vs 11.2 ms+/-1.8 ms; p=0.006; 57%+/-15.8% vs 36%+/-7.6%, p=0.003). Overall, these results contrast to these measures of control of upper trapezius, which did not differ to a healthy group.
The delay or absence of these reflexes and the delay and change in threshold of the corticospinal response in lower trapezius in subjects with NTSI indicate that the feedback mechanisms that aid shoulder girdle stability, and the voluntary control of lower trapezius are not as proficient in these subjects.
The control of lower trapezius should be considered when treating people with NTSI.
在健康受试者中，可从前臂和手部的肌肉传入神经诱发肩胛带肌肉（如斜方肌）的反射。这些反射被认为有助于在使用手臂和手部时维持肩部的稳定性[Alexander CM, Harrison PJ. 人类前臂和手部传入神经与肩胛带肌肉的反射连接。实验脑研究2003;148: 277 - 282。]。基于此，本研究的目的是检查非创伤性肩部不稳定（NTSI）受试者的这种斜方肌反射。
通过对尺神经和副神经进行电刺激以及对斜方肌运动皮层进行磁刺激，研究这种脊髓上反射通路的发生和改变。将这些结果与健康组进行比较。
NTSI受试者通常未观察到下斜方肌的反射。诱发时，其出现频率为27%，而健康人群为87%（p<0.002）。当下斜方肌反射出现时，其潜伏期比健康组更长（分别为62.8毫秒±28.1毫秒和38.4毫秒±3.6毫秒；p<0.009）。尽管有效传入神经的传导速度以及下斜方肌M反应的潜伏期与健康组无差异（分别为p<0.24和0.54），但下斜方肌皮质脊髓诱发电位的潜伏期和阈值确实存在差异（16.7毫秒±4.7毫秒对11.2毫秒±1.8毫秒；p = 0.006；57%±15.8%对36%±7.6%，p = 0.003）。总体而言，这些结果与上斜方肌的这些控制指标形成对比，上斜方肌的这些指标与健康组无差异。
NTSI受试者中这些反射的延迟或缺失以及下斜方肌皮质脊髓反应的延迟和阈值变化表明，有助于肩胛带稳定性的反馈机制以及下斜方肌的自主控制在这些受试者中并不那么有效。
在治疗NTSI患者时应考虑下斜方肌的控制。
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