Jaggi Anju, Alexander Susan
RNOHT - Therapies Dept Brockley Hill Stanmore Middlesex Stanmore HA7 4LP United Kingdom.
Open Orthop J. 2017 Aug 31;11:957-971. doi: 10.2174/1874325001711010957. eCollection 2017.
The shoulder relies predominantly on dynamic muscular control to provide stability. Successful treatment is highly dependent upon the correct clinical diagnosis, identification of anatomical structural defects and abnormal movement patterns so that rehabilitation programs can be designed accordingly and individualised to the patient.
A systematic outline is provided to guide the clinician on how to identify muscular insufficiencies both local to the shoulder joint and global muscles that can influence shoulder instability. Management is based on expert experience and current literature.
The Stanmore classification helps to correctly diagnose the type of instability and prioritise management. Symptom modification tests can help to guide management, however assessing individual muscle groups local to glenohumeral control is also recommended.
Physical and psychosocial factors can influence motor control in the presence of pain and injury. A multi-disciplinary approach is required to avoid recurrence of symptoms with rehabilitation focusing on kinetic chain, scapular and gleno-humeral control.
肩部主要依靠动态肌肉控制来提供稳定性。成功的治疗高度依赖于正确的临床诊断、解剖结构缺陷的识别以及异常运动模式的识别，以便能够据此设计康复计划并针对患者进行个性化定制。
提供了一个系统概述，以指导临床医生如何识别肩关节局部以及可能影响肩部不稳定的全身肌肉的肌肉功能不足。管理基于专家经验和当前文献。
斯坦莫尔分类有助于正确诊断不稳定类型并确定管理的优先级。症状修正测试有助于指导管理，但也建议评估肩肱关节控制局部的各个肌肉群。
身体和心理社会因素在存在疼痛和损伤的情况下会影响运动控制。需要采取多学科方法来避免症状复发，康复重点是动力链、肩胛骨和肩肱关节控制。
