Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
Ann Phys Rehabil Med. 2021 Jan;64(1):101457. doi: 10.1016/j.rehab.2020.10.008. Epub 2020 Nov 28.
Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.
This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.
The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration.
After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface.
There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.
多项研究报告称，盂肱关节和肩胛带肌肉活动以及肩胛带运动学在多向性肩不稳定（MDI）中很重要，但目前尚缺乏系统的综述。
本系统评价评估并总结了与健康对照组相比，MDI 个体的肌肉活动和肩部运动学的证据。
2020 年 9 月，通过关键词“MDI（人群）”“肌肉活动”和“盂肱关节和肩胛带运动模式”（结局），在 PubMed 和 Web of Science 电子数据库中进行检索。本综述纳入比较 MDI 肩与健康肩肌肉活动或肩胛运动学的研究，除外病例报告和病例系列研究。所有文章均通过标题和摘要进行筛选，剩余符合条件的文章进行全文筛选。根据 Cochrane 协作组织的建议，使用病例对照数据检查表评估纳入文章的偏倚风险。
经过全文筛选，有 12 篇文章符合纳入标准，另有 1 篇文章通过手工检索获得。根据荷兰医疗保健改进研究所的指南，大多数研究的方法学质量为中等。我们发现中度证据表明，MDI 个体的一些控制和中心肱骨头的肩袖肌肉活动增加或延长。此外，我们还发现一些使手臂和肩部运动或加速的肌肉活动减少和/或缩短，以及使手臂和肩部减速的肌肉活动增加和/或延长的证据。最一致的运动学发现是，与对照组相比，MDI 个体在肩胛平面抬起手臂时，肩胛向上旋转减少，内旋增加。最后，几项研究还表明，相对于关节盂表面，肱骨头的平移增加。
与健康对照组相比，MDI 个体存在肌肉活动改变和盂肱关节及肩胛带运动学改变的中度证据。
