Krobot PPT CB D

REHABILITATION
IN THE SHOULDER
MUSCULOSKELETAL PATHOLOGY
MUDr. Alois Krobot, Ph.D.
Klinika rehabilitace FN a LF UP
Olomouc
PAIN SHOULDER SYNDROMES
ONLY THREE CATEGORIES OF THE PEOPLE EXIST:
1) They have had
2) They have
3) They will have
ANY PAIN AND DYSFUNCTION OF THE SHOULDER
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PAIN SHOULDER DYSFUNCTION
REHABILITATION
/ MANUAL THERAPY / PHYSIOTHERAPY
CONCEPTS
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FUNDAMENTAL THESES
1) MYOFASCIAL TISSUES
2) FUNCTIONAL DISORDERS
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CORE PROBLEM: FUNCTIONAL MIND
FUNCTIONAL (PRAGMATIC) RHC STRATEGY
RECENT TREND:
RHC =
PREVENTIVE CARE
RHC =
AND THE SAME TIME
EARLY - STRUCTURED - GOAL DIRECTED
INTERVENTION
1) FUNCTIONAL (MOVEMENT) DIAGNOSTICS
2) FUNKCTIONAL (MANUAL) THERAPY
CORE PROBLEM:
EARLY (!) AND SPECIFIC (!) RHC INTERVENTION DEMANDS
ATTENTION TO VERY SUBTITLE CLINIC SYMPTOMS
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FUNCTIONAL BASIS IN REHABILITATION
CORNER STONE OF THE MODERN RHC
OPTIMAL FUNCTION OF THE MUSCLES
(IT HAS 2 DIMENSIONS)
OPTIMAL FUNCTION
OF THE MOTOR UNITS
(ONE MUSCLE)
OPTIMAL FUNCTIONAL
CO-ACTIVATION
(ALL MUSCLES : GIRDLE / BODY)
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FUNCTIONAL BASIS IN REHABILITATION
OPTIMAL FUNCTION OF THE MUSCLES
(2. DIMENSION)
MAIN GOAL: OPTIMAL FUNCTIONAL CO-ACTIVATION GIRDLE
MUSCLE WITH IN TERMS OF ALL BODY MUSCLES)
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FUNCTIONAL BASIS IN REHABILITATION
FUNCTIONAL CATEGORIZATION OF THE SHOULDER MUSCLES
(Basmaian, 1968; DeLuca 1989; Townsend, 1991; Moseley, 1992)
4P:
(P)rotectors (glenohumeral)
(P)ivotors (scapulohumeral)
scapular rotator muscles
(P)ositioners (humeral)
rotator cuff muscles
all parts of the deltoid
mBiBr + mTrBr (c.lg.)
(P)ower – driwers
mPectMjr + mLD
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ROLE OF THE GIRDLE MUSCLES:
NOT ONLY MOVEMENTS OF ARM and HAND
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GIRDLE MUSCLES: COMPLICITY IN
VENTILATION AND POSTURAL TASKS
“UPPER EXTREMITIES MOVEMENTS“ (UEM)
COMPLICITY GIRDLE MUSCLES IN ALL POSTURAL TASKS
(Enoca, 1999; Creswell,2000; Gandevia, 2005)
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GIRDLE MUSCLES: COMPLICITY IN
VENTILATION AND POSTURAL TASKS
antDelt dx
antDelt sin
__
postDelt dx
postDelt sin
__
mBiBr dx
mBiBr sin
__
mTrBr dx
mTrBr sin
__
mLD dx
mLD sin
__
mReFe dx
mReFe sin
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GIRDLE MUSCLES: COMPLICITY IN
VENTILATION AND POSTURAL TASKS
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SHOULDER PAIN :
ENTRAPMENT SYNDROMES
quadrilateral space sy (Cahill, 1983)
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SHOULDER PAIN :
ENTRAPMENT SYNDROMES
quadrilateral space sy
hypothetical patogenesis
USG (Dopler) argumentation
(Krobot, Vomáčka 2000)
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QUADRILATERAL SPACE SYNDROME : USG
Dopler argumentation : Poor effect Elevation+ExRotation of the
(Krobot, Vomáčka 2000)
humerus in indisposed patient
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QUADRILATERAL SPACE SY: THERAPY
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COSTO – CLAVICULAR SPACE SYNDROME
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COSTO – CLAVICULAR SPACE SYNDROME
Trendelenburg test evidens more than „insufficiency abductors“
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COSTO – CLAVICULAR SPACE SYNDROME
Trendelenburg test evidens more than „insufficiency abductors“
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COSTO – CLAVICULAR SPACE SYNDROME
Trendelenburg test evidens more than „insufficiency abductors“
(Krobot, Míková, 2000)
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COSTO – CLAVICULAR SPACE SYNDROME
ONE FORM OF THE THERAPY
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SHOULDER PAIN SYNDROMES : mLD
Frequent cause : STRAIN SY mLD
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SHOULDER PAIN SYNDROMES : mLD
STRAIN SY mLD : (SELF) PHYSIOTHERAPY
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SHOULDER PAIN SYNDROMES :
MORFOGENETIC VARIATIONES
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SHOULDER PAIN SYNDROMES :
MORFOGENETIC VARIATIONES
1)
Variations in human acromial posture:
FLAT / SMOOTH CURVE / ANTERIOR HOOK
(Bigliani, et all, 1983)
2)
Variation in the shape of the human scapula
„antropometric standard“ (Hrdlicka A, 1942)
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FUNCTIONAL CATEGORIZATION:
SHAPE´S VARIATIONES OF SCAPULA
STATISTICAL COMPARISON 3 METHODS
ANTROPOMETRY
DYNAMOMETRY
RADIOLOGY
322 healthy probands
189 msm patients
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FUNCTIONAL CATEGORIZATION:
SHAPE´S VARIATIONES OF SCAPULA
shape (0)
shape (1)
shape (2)
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FUNCTIONAL CATEGORIZATION:
SHAPE´S VARIATIONES OF SCAPULA
shape (3)
shape (4)
shape (5)
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FUNCTIONAL CATEGORIZATION:
SHAPE´S VARIATIONES OF SCAPULA
Tvar lopatky
Frekv
. [%]
20 %
15-20
%
Vy_sc
[cm]
In_sc
[%]
Uh_sc
[st]
Výko
n [N]
Označe
ní
adolesc
entní
ž <8
cm
m<9
cm
< 75 %
< 70 st.
ž< 7
N
m<8
N
ž = 8-9
cm
m = 911cm
75 – 85
%
70 - 80
st.
ž=6-9
N
m=811 N
astenic
ký
standar
tní
(ženský
)
1) area fossa infraspinata
and
2) length of mInfraSp
proximity
35%
Ž = 9-11
cm
m=1113 cm
85 – 95
%
80 - 90
st.
ž= 912 N
m=1
015N
1520%
Ž=1114cm
m=1215cm
90 –
100%
90 – 100
st.
ž> 12
N
m>1
5N
standar
tní
(mužsk
ý)
10%
ž > 14
cm
m=1420cm
> 100 st.
ž>14
N
m>3
0N
atletick
ý
> 105 %
Shape´s variationes of the
fossa infraspinata
-strenght and (!) first of all
the velocity of the
contraction
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Functional categorization
of the individual morphology of the scapula ?
postural position
and invidual morphology of
the scapula
(subtle) postural disorders
context
occasion
many musculoskeletal
syndromes
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REHABILITATION OF SHOULDER MUSCULOSKELETAL SYNDROMES
PREVENTION
ATTENTION FUNCTIONAL (SUBTLE) SYMPTOMS
(NO ONLY MOVEMENT OF GLENOHUMERAL JOINT
MANUAL THERAPY
KNOW-HOW
STRETCH OF THE PERIMYSIUM /NOT PROPER MUSCLE
REFLEX MANUAL THERAPY
EDUCATION OF NEUROMUSCULAR STABILIZATION
REHABILITATION EXCERCISE PROGRAMME
GOAL
CO-ACTIVATION MUSCLES FOR STABILIZATION
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REHABILITATION PROGRAMME:
CO-ACTIVATION MUSCLES FOR STABILIZATION
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RECENT REHABILITATION FORMS:
SPECIFIC FUSION:
1)REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
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RECENT REHABILITATION FORMS: FUSION :
1) REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
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RECENT REHABILITATION FORMS: FUSION :
1) REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
Porovnání aktivace svalů ABD+ZR LHK
8
7
6
násobky 5
aktivační 4
hodnoty 3
2
1
0
SCM SCM TB
l.sin. l.dx. l.sin.
příjem
TB
l.dx.
BB
l.sin.
BB
l.dx.
LD
l.sin.
LD
l.dx.
propuštění
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RECENT REHABILITATION FORMS: FUSION :
1) REGIONAL ANAESTHESIA + 2) PHYSIOTHERAPY
Porovnání aktivačních hodnot
30
uV
SCM l.sin. µV
25
SCM l.dx. µV
20
TB l.sin. µV
TB l.dx. µV
15
BB l.sin. µV
10
BB l.dx. µV
5
LD l.sin. µV
LD l.dx. µV
0
prijem
blok
propusteni
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TD na LDK
7
6
5
násobky
4
aktivačních
3
hodnot
2
1
0
SCM SCM TB
l.sin. l.dx. l.sin.
příjem
blok
TB
l.dx.
BB
l.sin.
BB
l.dx.
LD
l.sin.
LD
l.dx.
propuštění
TD na PDK
5
4
násobky 3
aktivačních
2
hodnot
1
0
SCM SCM TB
l.sin. l.dx. l.sin.
příjem
blok
TB
l.dx.
BB
l.sin.
BB
l.dx.
propuštění
Krobot
LD
l.sin.
LD
l.dx.
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GENERAL DRIFT OF RECENT REHABILITATION PROGRAMMES
RECOVERY :
COMPREHENSIVE
PHYSIOLOGICAL
MUSCLE´S FUNCION
[email protected]
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