Saint John's Hospital, Department of Orthopaedics and Traumatology, 1125 Budapest Diósárok 1-3, Hungary.
J Electromyogr Kinesiol. 2009 Dec;19(6):e438-47. doi: 10.1016/j.jelekin.2008.09.008. Epub 2008 Dec 4.
The aim of this study was to compare the muscle activity of patients with multidirectional instability treated in a conservative or complex manner (capsular shift with postoperative rehabilitation) and the muscle activity of stable shoulder joints before and after treatment during pull, push, and elevation of upper extremities and during overhead throw.
The study was carried out on 34 patients with multidirectional shoulder instability treated non-operatively, on 31 patients with multidirectional shoulder instability treated operatively, and on 50 healthy subjects. Signals were recorded by surface EMG from eight different muscles. The mean and standard deviation of the maximum amplitude of normalized voluntary electrical activity for the different movement types and time broadness values during overhead throw were determined for each muscle in all groups and compared with each other.
The centralization of the glenohumeral joint and the reduction of instability is attempted to be ensured by the organism through increasing the role of rotator cuff muscles (p=0.009) and decreasing the role of the deltoid, biceps brachii, and pectoralis maior muscles (p=0.007). At patients after short-term and long-term conservative treatment, the maximum amplitude of normalized voluntary electrical activity of stabilizer muscles is significantly higher (p=0.006), and that of accelerator muscles is significantly lower (p=0.005) and the time broadness is significantly longer (p=0.01) than that of the control group. At patients after complex treatment (open capsular shift with postoperative conservative rehabilitation) the characteristic of the muscle pattern is similar (p=0.19) to the control group. The complex treatment resolves the labral ligamentous abnormalities by operative treatment and restores the impaired muscular control by postoperative rehabilitation, whereas the conservative treatment restores only the muscular control.
本研究旨在比较保守治疗和复杂治疗（囊袋移位术联合术后康复）多向性不稳定患者的肌肉活动，以及治疗前后稳定肩部关节在拉、推、抬高上肢和过头投掷时的肌肉活动。
本研究对 34 例非手术治疗的多向性肩不稳定患者、31 例手术治疗的多向性肩不稳定患者和 50 例健康受试者进行了研究。使用表面肌电图从 8 块不同的肌肉记录信号。在所有组中，确定了不同运动类型和过头投掷时时间宽度值的最大幅度标准化自愿电活动的平均值和标准差，并相互比较。
机体试图通过增加肩袖肌肉的作用（p=0.009）和减少三角肌、肱二头肌和胸大肌的作用（p=0.007）来确保盂肱关节的中心化和不稳定的减少。在短期和长期保守治疗后的患者中，稳定肌的最大幅度标准化自愿电活动明显较高（p=0.006），加速肌的明显较低（p=0.005），时间宽度明显较长（p=0.01），与对照组相比。在复杂治疗（开放囊袋移位术联合术后保守康复）后的患者中，肌肉模式的特征与对照组相似（p=0.19）。复杂治疗通过手术治疗解决了盂唇韧带异常，并通过术后康复恢复了受损的肌肉控制，而保守治疗仅恢复了肌肉控制。
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