School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Rm. 327, 3F., No. 17, Xuzhou Rd. Zhongzheng Dist, Taichung, Taipei City, 100, Taiwan.
Arch Orthop Trauma Surg. 2024 May;144(5):2039-2046. doi: 10.1007/s00402-024-05316-3. Epub 2024 Apr 13.
In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear.
A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system.
The acromiohumeral distance significantly increased during NMES of the teres major (0.73 mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78 mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003).
NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement.
在患有肩袖撕裂的有症状患者中，MRI 和影像学研究将疼痛症状归因于手臂抬高过程中肱骨头的不足够下抑。臂内收肌（如大圆肌和胸大肌）可能有助于手臂抬高过程中肱骨头的下抑。研究人员已经证明，前锯肌和下斜方肌的神经肌肉电刺激（NMES）可以控制肩胛骨运动并改善肩峰肱骨关节距离。然而，尚不清楚内收肌神经肌肉训练是否有助于肩袖撕裂患者。
对 30 名患有肩袖撕裂的有症状患者进行了三角肌和胸大肌 NMES 的横断面研究。我们通过超声测量了肩峰肱骨关节距离，并通过三维运动跟踪系统测量了手臂抬高过程中的肩胛骨运动。
三角肌 NMES 时肩峰肱骨关节距离显著增加（0.73 毫米，p<0.001）。然而，胸大肌 NMES 时该距离显著减小（0.78 毫米，p<0.001）。此外，三角肌 NMES 时肩胛骨上旋角度大于胸大肌 NMES（3.4°，p<0.001）。胸大肌 NMES 时肩胛骨外旋角度减小显著大于三角肌 NMES（1.6°，p=0.003）。
三角肌 NMES 可增加手臂抬高过程中的肩峰肱骨关节距离和肩胛骨上旋。然而，胸大肌 NMES 时肩胛骨的上旋和外旋减小可能与肩峰下撞击有关。
