Skoumal Connor, Dewald Matt
Int J Sports Phys Ther. 2024 Feb 1;19(2):238-244. doi: 10.26603/001c.91642. eCollection 2024.
Effective rehabilitation strategies for upper extremity injuries in softball pitchers are scarce in current literature, especially among youth athletes. Additionally, there continues to be ambiguity regarding the interpretation and clinical practicality when treating an overhead athlete with scapular dyskinesis. The purpose of this case report is to highlight the examination and treatment of a youth softball pitcher referred to physical therapy with the diagnosis of scapular dyskinesis.
This case report presents data and outcomes for a 14-year-old female who experienced chronic right shoulder discomfort related to performing the windmill softball pitch (WSP). The subject was clinically diagnosed with scapular dyskinesis by her referring physician and demonstrated abnormal scapular movement when elevating and lowering her upper extremity. Internal and external rotator isokinetic strength testing and the Athletic Shoulder Test (ASH) were used as primary objective measures. Both were performed six days after the initial evaluation and again six weeks later. Initial testing demonstrated decreased peak torque and total work. Initial treatment involved periscapular and shoulder strengthening with progression to overhead loading. Later rehabilitation strategies focused on neuromuscular control, functional training, and sport-specific activities.
The subject initially demonstrated improved peak torque and total work of the shoulder with isokinetic strength testing but continued to have symptoms with pitching, even though the Scapular Dyskinesis Test had become negative. After changing the focus to neuromuscular and functional training the subject had fewer symptoms and became comfortable with self-management.
This case matches previous research that endorses scapular dyskinesis being a normal finding in overhead athletes with and without shoulder pain. Neuromuscular control and functional training after a period of scapular strengthening were beneficial in improving symptoms in this athlete.
目前的文献中缺乏针对垒球投手上肢损伤的有效康复策略，尤其是在青少年运动员中。此外，在治疗患有肩胛运动障碍的过头运动运动员时，对于其解读和临床实用性仍存在模糊之处。本病例报告的目的是强调一名被诊断为肩胛运动障碍而转诊至物理治疗的青少年垒球投手的检查和治疗情况。
本病例报告展示了一名14岁女性的数据和结果，该女性因进行风车式垒球投球（WSP）而经历慢性右肩不适。转诊医生临床诊断该受试者患有肩胛运动障碍，且在其上肢抬高和降低时表现出异常的肩胛运动。内旋和外旋等速肌力测试以及运动肩测试（ASH）被用作主要客观指标。两者均在初始评估后六天进行，六周后再次进行。初始测试显示峰值扭矩和总功降低。初始治疗包括肩胛周围和肩部强化训练，并逐渐过渡到过头负荷训练。后期的康复策略侧重于神经肌肉控制、功能训练和特定运动活动。
受试者在等速肌力测试中最初显示肩部峰值扭矩和总功有所改善，但尽管肩胛运动障碍测试已呈阴性，但投球时仍有症状。在将重点转向神经肌肉和功能训练后，受试者症状减轻，并对自我管理感到满意。
本病例与先前的研究相符，该研究认可肩胛运动障碍在有或无肩部疼痛的过头运动运动员中都是常见表现。在一段时间的肩胛强化训练后进行神经肌肉控制和功能训练，对改善该运动员的症状有益。
5级。
