PRO Sports Physical Therapy, Scarsdale, New York, USA.
Am J Sports Med. 2010 Jan;38(1):114-9. doi: 10.1177/0363546509346050. Epub 2009 Dec 4.
Glenohumeral internal rotation deficit (GIRD) and posterior shoulder tightness have been linked to internal impingement.
To determine if improvements in GIRD and/or decreased posterior shoulder tightness are associated with a resolution of symptoms.
Cohort study; Level of evidence, 3.
Passive internal rotation and external rotation (ER) range of motion (ROM) at 90 degrees of shoulder abduction and posterior shoulder tightness (cross-chest adduction in side lying) were assessed in 22 patients with internal impingement (11 men, 11 women; age 41 +/- 13 years). Treatment involved stretching and mobilization of the posterior shoulder. The Simple Shoulder Test (SST) was administered on initial evaluation and discharge. Changes in GIRD, ER ROM, and posterior shoulder tightness were compared between patients with complete resolution of symptoms versus patients with residual symptoms using independent t tests.
Patients had significant GIRD (35 degrees), loss of ER ROM (23 degrees), and posterior shoulder tightness (35 degrees) on initial evaluation (all P < .01). Physical therapy (7 +/- 2 weeks; range, 3-12 weeks) improved GIRD (26 degrees +/- 14 degrees; P < .01), ER ROM loss (14 degrees +/- 20 degrees), and posterior shoulder tightness (27 degrees +/-19 degrees). The SST improved from 5 +/- 3 to 11 +/- 1 (P < .01). A greater improvement in posterior shoulder tightness was seen in patients with complete resolution of symptoms (n = 12) compared with patients with residual symptoms (35 degrees vs 18 degrees; P < .05). Improvements in GIRD and ER ROM loss were not different between groups (GIRD, 25 degrees vs 28 degrees, P = .57; ER ROM, 14 degrees vs 15 degrees, P = .84).
Resolution of symptoms after physical therapy treatment for internal impingement was related to correction of posterior shoulder tightness but not correction of GIRD.
盂肱关节内旋不足（GIRD）和肩后紧是与内撞击有关的。
确定 GIRD 的改善和/或肩后紧的减轻是否与症状的缓解有关。
队列研究；证据水平，3 级。
对 22 例肩内撞击患者（11 名男性，11 名女性；年龄 41±13 岁）进行了肩关节外展 90°时的被动内旋和外旋（ER）活动度（ROM）以及肩后紧（侧卧时交叉抱胸）的评估。治疗包括肩后伸展和松动。在初始评估和出院时进行简易肩部测试（SST）。使用独立 t 检验比较完全缓解症状的患者与仍有症状的患者之间 GIRD、ER ROM 和肩后紧的变化。
患者初始评估时存在明显的 GIRD（35°）、ER ROM 丧失（23°）和肩后紧（35°）（均 P<.01）。物理治疗（7±2 周；范围 3-12 周）改善了 GIRD（26°±14°；P<.01）、ER ROM 丧失（14°±20°）和肩后紧（27°±19°）。SST 从 5±3 提高到 11±1（P<.01）。完全缓解症状的患者（n=12）与仍有症状的患者（35°比 18°；P<.05）相比，肩后紧的改善更为明显。GIRD 和 ER ROM 丧失的改善在两组之间无差异（GIRD，25°比 28°，P=.57；ER ROM，14°比 15°，P=.84）。
物理治疗治疗肩内撞击后症状的缓解与肩后紧的纠正有关，而与 GIRD 的纠正无关。
