Avila Mariana Arias, Camargo Paula Rezende, Ribeiro Ivana Leão, Zamunér Antonio Roberto, Salvini Tania Fátima
Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil.
Clin Biomech (Bristol). 2014 Aug;29(7):815-21. doi: 10.1016/j.clinbiomech.2014.05.007. Epub 2014 May 29.
The core feature of fibromyalgia is pain, which may play a role in various mechanisms that might lead to alterations in shoulder kinematics. Alterations in muscle activity and presence of tender points in the shoulder girdle have already been described in this population; however there is lack of evidence on three-dimensional scapular motion in women with fibromyalgia.
Forty women with fibromyalgia and 25 healthy women (control group) matched in terms of age, weight and height, took part in this study. Three-dimensional scapular kinematics of the dominant arm were collected during elevation and lowering of the arm in the sagittal and scapular planes. Pain was evaluated by the Visual Analogue Scale and the Numerical Pain Rating Scale. Group comparisons were performed with one-way ANOVA for pain and two-way ANOVA for the kinematic variables (scapular internal/external rotation, upward/downward rotation and anterior/posterior tilt), with group and humeral elevation angle as categorical factors. Significance level was set at P<0.05.
Fibromyalgia women presented higher pain scores (P<0.001) than the control group. Fibromyalgia women also presented greater scapular upward rotation (P<0.001, both planes) and greater scapular posterior tilt (P<0.001, both planes) than the control group.
Women with fibromyalgia present greater scapular upward rotation and posterior tilt in the resting position and during arm elevation and lowering of the arm in sagittal and scapular planes. These alterations may be a compensatory mechanism to reduce pain during arm movement.
纤维肌痛的核心特征是疼痛，疼痛可能在各种机制中起作用，这些机制可能导致肩部运动学改变。该人群中已经描述了肌肉活动的改变和肩胛带压痛点的存在；然而，关于纤维肌痛女性三维肩胛骨运动的证据不足。
40名患有纤维肌痛的女性和25名年龄、体重和身高相匹配的健康女性（对照组）参与了这项研究。在手臂在矢状面和肩胛面上升和下降过程中，收集优势手臂的三维肩胛骨运动学数据。通过视觉模拟量表和数字疼痛评分量表评估疼痛。采用单因素方差分析比较组间疼痛，采用双因素方差分析比较运动学变量（肩胛骨内/外旋转、上/下旋转和前/后倾斜），以组和肱骨抬高角度作为分类因素。显著性水平设定为P<0.05。
纤维肌痛女性的疼痛评分高于对照组（P<0.001）。纤维肌痛女性在矢状面和肩胛面的肩胛骨上旋（P<0.001，两个平面）和肩胛骨后倾（P<0.001，两个平面）也比对照组更大。
纤维肌痛女性在休息时以及手臂在矢状面和肩胛面上升和下降过程中，肩胛骨上旋和后倾更大。这些改变可能是手臂运动时减轻疼痛的一种代偿机制。
