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REHABILITACIÓN EN INESTABILIDAD DE HOMBRO

INTRAR

Lic. Andrés Romañuk

ESTABILIDAD

· Conjuntamente entre Ligamentos, labrum y capsula · Dinamicamente Manguito rotador · Correcta mecanica escapular

Electromyographic anlysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. Reinold MM, Macrina LC, Wilk KE, Fleisig GS, Dun S, Barrentine SW, Ellerbusch MT, Andrews JR. J Athl Train. 2007 Oct-Dec;42(4):464-9.

ESTABILIDAD

CLASIFICACIÓN

· · · · · Atraumatic Multidireccional Bilateral Rehab Inferior capsular shift · · · · Traumatic Unidireccional Bankart Surgery

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INESTABILIDAD MENOR

AIOS

· Acquired · Instability · Overstressed · Shoulder Surgery

AMSI

· Atraumatic · Minor · Shoulder · Instability

Minor shoulder instability. Castagna A, Nordenson U, Garofalo R, Karlsson J. Arthroscopy. 2007 Feb; 23 (2); 211-5..

MR PATOLOGICO

· Alteración cinematica y actividad muscular · Aumento traslación humeral superior · Abd. 30°-90°, dism. EMG infraesp y subescapular

Graichen H, Bonel H, Stammberger T, et al. Threedimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome. AJR Am J Roentgenol. 1999;172:1081-1086. Hess SA, Richardson C, Darnell R, Friis P, Lisle D, Myers P. Timing of rotator cuff activation during shoulder external rotation in throwers with and without symptoms of pain. J Orthop Sports Phys Ther. 2005;35:812-820. jospt.2005.2134 Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction. Clin Orthop Relat Res. 1978;165-170.

INESTABILIDAD E HIPERLAXITUD

· Idem MR patologico. ( subesc. RI, subesc. y supra RE) · Inestab. anterior, supra. 30-60°Abd.

Brostrom LA, Kronberg M, Nemeth G. Muscle activity during shoulder dislocation. Acta Orthop Scand. 1989;60:639-641. Illyes A, Kiss RM. Electromyographic analysis in patients with multidirectional shoulder instability during pull, forward punch, elevation and overhead throw. Knee Surg Sports Traumatol Arthrosc. 2007;15:624 631. Labriola JE, Jolly JT, McMahon PJ, Debski RE. Active stability of the glenohumeral joint decreases in the apprehension position. Clin Biomech (Bristol, Avon). 2004;19:801-809. Labriola JE, Lee TQ, Debski RE, McMahon PJ. Stability and instability of the glenohumeral joint: the role of shoulder muscles. J Shoulder Elbow Surg. 2005;14:32S-38S. Matias R, Pascoal AG. The unstable shoulder in arm elevation: a three-dimensional and electromyographic study in subjects with glenohumeral instability. Clin Biomech (Bristol, Avon). 2006;21 Suppl 1:S52-58 Santos MJ, Belangero WD, Almeida GL. The effect of joint instability on latency and recruitment order of the shoulder muscles. J Electromyogr Kinesiol. 2007;17:167-175. Ogston JB, Ludewig PM. Differences in 3-dimensional shoulder kinematics between persons with multidirectional instability and asymptomatic controls. Am J Sports Med.

BIOMECÁNICA

EVALUAR

· Diskinesia y capsula posterior (GIRD) · Postura y desequilibrios musculares · Control pelvico y lumbar

DISKINESIA - SICK

· Scapular malposition · Inferior medial border prominence · Coracoid pain and malposition · DysKinesis of scapular movement

The Role of the Scapula in Athletic Shoulder Function. Am. J. Sports Med. 1998; 26; 325 W. Ben Kibler

DISKINESIA - SICK

TIPOS DE DISKINESIA

· Tipo I, prominencia borde escapular inferomedial · Tipo II, prominencia borde escapular medial completo · Tipo III, prominencia borde superomedial

Current Concepts. The Disabled Throwing Shoulder: Spectrum of Pathology. Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation. Stephen S. Burkhart, M.D., Craig D. Morgan, M.D., and W. Ben Kibler, M.D.

TIPOS DE DISKINESIA

EVALUACIÓN SICK

· · · · Tipo sick Lateral Scapular Slide Test (LSST) Test retracción y asistencia escapular Test McClure (dinámico)

The Role of the Scapula in Athletic Shoulder Function. Am. J. Sports Med. 1998; 26; 325 W. Ben Kibler

EVALUACIÓN SICK

EVALUACIÓN SICK

EVALUACIÓN SICK

EVALUACIÓN SICK

EVALUACIÓN SICK

A Clinical Method for Identifying Scapular Dyskinesis, Part 1: Reliability Philip McClure, PhD, PT*; Angela R. Tate, PhD, PT*; Stephen Kareha, DPT, PT, ATC, CSCS`; Dominic Irwin, DPT, PT; Erica Zlupko, DPT, PTI

EVALUACIÓN SICK

A Clinical Method for Identifying Scapular Dyskinesis, Part 1: Reliability Philip McClure, PhD, PT*; Angela R. Tate, PhD, PT*; Stephen Kareha, DPT, PT, ATC, CSCS`; Dominic Irwin, DPT, PT; Erica Zlupko, DPT, PTI

EVALUAR CAPSULA POSTERIOR

EVALUAR CAPSULA POSTERIOR

EVALUAR CONTROL PELVICO

The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation Stephen S. Burkhart, M.D., Craig D. Morgan, M.D., and W. Ben Kibler, M.D.

The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation Stephen S. Burkhart, M.D., Craig D. Morgan, M.D., and W. Ben Kibler, M.D.

EVALUAR CONTROL PELVICO

The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation Stephen S. Burkhart, M.D., Craig D. Morgan, M.D., and W. Ben Kibler, M.D.

EVALUAR CONTROL LUMBAR

The Disabled Throwing Shoulder: Spectrum of Pathology Part III: The SICK Scapula, Scapular Dyskinesis, the Kinetic Chain, and Rehabilitation Stephen S. Burkhart, M.D., Craig D. Morgan, M.D., and W. Ben Kibler, M.D.

OBJETIVOS

DOLOR

·Fisioterapia ·Técnicas manuales

FORTALECIMIENTO Y ESTABILIDAD

· Estabilizadores primarios · Estabilizadores secundarios · Periescapulares · Zona media · Miembros inferiores

FLEXIBILIZACION

SUPRAESPINOSO

SUPRAESPINOSO

SUPRAESPINOSO

SUPRAESPINOSO

BIOMECÁNICA

· Empty Can genera un vector mayor orientado a superior · La RI extrema va disminuyendo el brazo de palanca del supra. a medida que aumenta la Abd. de 0 a 90°, poniendolo en desventaja mecanica y generando un stress de tensión, derivando en compensaciones · Además aumenta la Tensión en caps. Posteroint. y MR (infraesp), contribuyendo en Tilt ant., RI escapular, y protracción

BIOMECÁNICA

INFRAESPINOSO Y REDONDO MENOR

· EMG en RE decub. Lat. · RE en plano escap. 45°Abd · RE prono 90°abd

Reinold MM, Wilk KE, Fleisig GS, et al. Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises. J Orthop Sports Phys Ther. 2004;34:385-394.

INFRAESPINOSO Y REDONDO MENOR

INFRAESPINOSO Y REDONDO MENOR

INFRAESPINOSO Y REDONDO MENOR

INFRAESPINOSO Y REDONDO MENOR

INFRAESPINOSO Y REDONDO MENOR

INFRAESPINOSO Y REDONDO MENOR

SUBESCAPULAR

· Compresión glenohumeral, RI y estab. Anterior · Datos inconclusos subesc EMG RI a 0° o 90° Abd, pero a 90°Abd, el pect > y dorsal ancho EMG · EMG subesc. Push up plus, dynamic hug y >act. EMG «ejerc. diagonal».

Decker MJ, Tokish JM, Ellis HB, Torry MR, Hawkins RJ. Subscapularis muscle activity during selected rehabilitation exercises. Am J Sports Med. 2003;31:126-134.

SUBESCAPULAR

SUBESCAPULAR

SERRATO ANTERIOR

· Importante en rotación superior, tilt posterior y rotación externa · Acelera la escapula en la fase de lanzamiento («throwing») · Estabiliza el borde medial y ang. Inf escapular (prev. Winging) y tilt anterior · 90°abd RI o RE ayuda a estab. escapula

Ludewig PM, Cook TM, Nawoczenski DA. Threedimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. 1996;24:57-65. McClure PW, Michener LA, Sennett BJ, Karduna AR. Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg.

SERRATO ANTERIOR

· act. push up plus pared, Push up plus de rodillas, push up plus standard, · Plus: protracción escap. despues de extens. completa de codos · 3 ejercicios EMG, push up plus, dynamic hug y punch (piña)

Ludewig PM, Hoff MS, Osowski EE, Meschke SA, Rundquist PJ. Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med. 2004;32:484-493. Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27:784-791.

SERRATO ANTERIOR

SERRATO ANTERIOR

SERRATO ANTERIOR

· Ejercicio Wall slide (deslizar), pacientes describen menos dolor durante realiz. · CCC · Compresión contra glenoides - estabilid? · Para primeras fases?

Hardwick DH, Beebe JA, McDonnell MK, Lang CE. A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. J Orthop Sports Phys Ther

SERRATO ANTERIOR

SERRATO ANTERIOR

SERRATO ANTERIOR

SERRATO ANTERIOR

SERRATO ANTERIOR

SERRATO ANTERIOR

TRAPECIO

· UT, rotación superior y elevación · MT, retracción · LT, rotación superior y depresión, contribuye tilt post. y RE

Ludewig PM, Cook TM, Nawoczenski DA. Threedimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. 1996;24:57-65. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80:276-291. Graichen H, Bonel H, Stammberger T, et al. Threedimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome. AJR Am J Roentgenol. 1999;172:1081-1086.

TRAPECIO MEDIO

· Relativamente alta activ. con encogimiento hombro, remo prono y abd. Prono horizont. a 90°y 120°

Moseley JB, Jr., Jobe FW, Pink M, Perry J, Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20:128-134. Ekstrom RA, Donatelli RA, Soderberg GL. Surface electromyographic analysis of exercises for the trapezius and serratus anterior muscles. J Orthop Sports Phys Ther. 2003;33:247-258.

TRAPECIO MEDIO

TRAPECIO MEDIO

TRAPECIO MEDIO

TRAPECIO MEDIO

TRAPECIO BAJO

· RE bilateral Abd. 0° mejor ratio entre UT-LT · Buen ratio, RE decub. Lat. y Abd. Horizontal prono a 90° y 135° con RE

McCabe RA. Surface electromyographic analysis of the lower trapezius muscle during exercises performed below ninety degrees of shoulder elevation in healthy subjects. N Am J Sports Phys Ther. 2007;2:34-43. Cools AM, Dewitte V, Lanszweert F, et al. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007;35:1744-1751.

TRAPECIO BAJO

MUCHAS GRACIAS

Lic. Andrés Romañuk [email protected]

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AATD Inestabilidad hombro

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