骨骼肌肉系統(tǒng)：肩關(guān)節(jié)治療

1、Treatment of the shoulderPainstiff健康的組織結(jié)構(gòu)是無痛的，錯誤的組織結(jié)構(gòu)才會引起疼痛Structure Classification: contractile and noncontractile (inert) structures. 非收縮組織(Non-Contractile): Ligament, capsule, fasciae筋膜, bursa滑囊 收縮組織(Contractile: ability to contract and relax): muscles 治療開始于評定終止于評定Objective examination of the sho

2、ulderInspection視診Movement Testing運動測試Palpation 觸診Observation Functional activitiesActive movementPassive movementResisted testingObservation Done in sittingInspect body alignments , contours輪廓 of muscles and jionts from anterior , posterior ,laterior and superior aspectsFunctional activitiesObserve

3、patterns of movement for compensatory or trick movement代償 in other body parts.What are the common daily activities that could be assessed ?Movement Tests: SequencingActive MovementsPassive MovementsResisted MovementsRepeated MovementsAuxillary TestsKeys of Active Movements它沒有辦法區(qū)分收縮組織或非收縮組織的病變。Keys o

4、f Passive Movementsindicates the state of the inert tissues3 domains Restriction PatternCapsular / NoncapsularEnd-feelPain-Resistance SequenceLigamentous adhesions: 局部的疼痛，拉伸韌帶的動作會發(fā)生不適。Internal derangement: 局部的疼痛，動作因關(guān)節(jié)內(nèi)紊亂而受限.Extraarticular limitation: 在某 1 方向活動限制、其他的方向ROM 完全無痛End-feelsEnd-feels可以正?；虿?/p>

5、態(tài)，取決于: 關(guān)節(jié)? 2. 發(fā)生的點End feelsBone to bone: elbow extension Tissue approximation: elbow flexion Tissue Stretch: finger extension, shoulder rotation ABNORMA Spasm: muscle spasm Capsular (Hard): frozen shoulder (pain) Springy block: meniscus tearEmptyNORMAL此順序可反映出不舒服的程度和有助于確定治療的強度Pain before resistance:

6、Inflammatory Dominant Stage(發(fā)炎)Pain synchronous with resistance: Repair Stage(修復(fù))Resistance before pain: Remodeling Stage(在塑)Resisted test Examiner and patients strength must be fairly even matched. Muscles should be isolated. Resisted isometric contraction (no movement). Interpretation of Resisting

7、TestingInterpretation of ResistingTestingRepeated Tests如果肩胛骨以適當(dāng)?shù)墓?jié)奏與 盂肱關(guān)節(jié)暫時移動；肱骨頭 (球) 仍然是居中 (紅色箭頭) 在glenois套接(藍(lán)色箭頭)中Principle of Shoulder StrengtheningTherapeutic intervention for the shoulderTherapeutic intervention for the shoulderPain relieving techniques1.Passive mobilization technique(a)Accessor

8、y movement ,lat,caud(b)Physiological movement F,Abd,rotation2.Electrophysical agentsImproving hypomobility(range of motion)1.Using active mobilization techniqueTherapeutic intervention for the shoulderImproving hypomobility(range of motion)2.Passive mobilization techniqueImproving hypomobility(range

9、 of motion)3.Stretching exercises to improve flexibilityPect. MajorPect. MinorTrapeziusTricepsBicepsPostero-inferior capsuleImproving hypomobility(range of motion)4.Soft tissue mobilization-deep friction massage for scar adhesions肩井穴注意Muscle strengthening exercises1.Rotator cuff musclesSupraspinatus

10、（Abd ）Subscapularis（IR）Teres minor and infraspinatus （ER）Therapeutic intervention for the shoulder2.Scapular musclesStart with stabilization exercises , then gradually isolate different muscle groups for different functions , with increasing difficultyGentle stabilization exercises:Scapular PNF patt

11、ernIsometric scapular retractionsWall washesFour point kneelingIsolated different groups of musclesSerratus anterior (protraction)Rhomboids and middle trapezius(retraction)Latissmus dorsi and pectoralis minor(depression)Upper rapezius and levator scapulae(elevation)Serratus anterior and trapezius(upward rotation)Rhomboids and pectoralis minor(downward rotation)Think of :Starting positionType of exercise (isometr