肩胛骨運動異常之評估與介入:型態特性、知覺控制與貼紮效果

Evaluation and Intervention of Scapular Dyskinesis: Pattern Characteristics, Conscious Control, and Taping Effect

黃崇舜(Tsun-Shun Huang)

指導教授 ： 林居正

國立臺灣大學/醫學院/物理治療學研究所/博士(2017年)

https://doi.org/10.6342/NTU201702414

摘要

肩胛骨運動異常定義為肩胛骨相對於胸廓的位置與動作改變。過去文獻顯示有百分之33到100的肩膀疾患者包含旋轉肌群損傷、盂肱關節不穩定與關節唇撕裂可以見到肩胛骨運動異常的現象，但目前肩膀疾患與肩胛骨運動異常之因果關係目前仍有不一致的結果。肩胛胸廓關節之評估對於恢復肩膀疾患者之肩膀功能甚為重要。評估肩胛骨運動異常之方法包含視覺觀察、矯正測試、量測肩胛骨位移與複雜儀器如三維動作分析系統。為改善肩胛骨運動異常之評估方法，第一章之研究發展視覺觀察配合觸診方法分類特殊形態並探討其信度。第二章之研究發展改良式肩胛量測器測量肩胛骨內緣與下角向後側翻起之距離並探討其信度與效度。
瞭解肩胛骨運動異常特定形態之特性可以協助肩膀疾患者之治療與預防。根據第一章研究之方法，第三章之研究探討肩胛骨運動異常特定型態者在執行舉手放下動作時肩胛骨動作學與肌肉活動性。第四章之研究以更多之受試者使用主成分分析法來評估特定動作異常型態之過肩運動員其動作特性。此外，第五章之研究探討特定型態是否與肩膀失能相關以及找出與肩膀失能之相關因子。
肩胛骨動作異常之適當介入需涵蓋造成異常之所有因子並利用恢復肌肉力量間之平衡來維持適當的肩胛骨位置與動作。臨床上，肌內效貼紮被使用來恢復肌肉活動性與動作但目前未有針對肩胛骨動作異常患者進行探討。第六章之研究探討對於肩胛骨動作異常患者使用貼紮在斜方肌上對於肩胛骨動作學與肌肉活動性之效果。此外，肩胛骨知覺控制也認為可以改善肩胛骨動作學與肌肉活動性。探討知覺控制在有症狀之肩胛骨運動異常患者之文獻有限。第七章之研究探討使用知覺控制對於肩胛骨運動異常患者之動作學與肌肉活動性之改變。根據第七章研究之發現，輔助訓練器材像即時錄影回饋與改良之漸進式控制計畫可以改善直立姿勢下舉手時之效果。第八章之最終研究探討針對肩峰下夾擠症與肩胛內緣族群在進行漸進式肩胛骨控制時是否使用即時錄影回饋對舉手動作之肩胛骨動作學與肌肉活動性之影響。這些章節將涵蓋肩胛骨動作異常之評估、型態特性與介入等層面。

關鍵字

肩胛骨動作異常 ； 型態 ； 動作學 ； 肌肉活動 ； 評估 ； 介入

並列摘要

Scapular dyskinesis was defined as alteration of scapular position and movement relative to thoracic cage. Previous studies demonstrated that 33 to 100 percent of patients with shoulder disorders including rotator cuff injuries, glenohumeral instability, labral tears have scapular dyskinesis, although cause-effect relationship between shoulder disorders and scapular dyskinesis has been still unclear and with conflict findings. Evaluation of scapulothoracic joint is an essential part for restoring shoulder dysfunction in patients with shoulder disorders. Methods to assess scapular dyskinesis include visual observation, corrective maneuvers, measurement of scapular displacement, and complicated tools such as 3-D motion analysis systems. To improve the methods of evaluating scapular dyskinesis, our research in Chapter 1 developed visual observation with palpation methods to classify specific patterns and investigated the reliability of this comprehensive method. Research in Chapter 2 developed modified scapulometer to measure the posterior displacement of medial border and inferior angle of scapula and investigated the reliability and validity of this tool.
Understanding the characteristics of specific scapular dyskinesis pattern may help the treatment and prevention of shoulder disorders with scapular dyskinesis. According to the methods developed in Chapter 1, research in Chapter 3 investigated scapular kinematics and associated muscular activation during arm raising/lowering movements in individuals with specific scapular dyskinesis pattern. With more participants recruited, research in Chapter 4 used principal component analysis to assess the movement characteristics of specific dyskinesis pattern in overhead athletes. Additionally, research in Chapter 5 investigated whether shoulder dysfunction were related to unique patterns of scapular dyskinesis and found the related factors associated with shoulder dysfunction in specific scapular dyskinesis pattern.
Optimal intervention of scapular dyskinesis requires addressing all of the factors that can create the dyskinesis and then restoring the balance of muscle forces to maintain appropriate scapular position and motion. Clinically, kinesio taping (KT) has been used to restore muscle activities and kinematics but has not been investigated in patients with scapular dyskinesis. Research in Chapter 6 investigated the effects of trapezius kinesio taping on scapular kinematics and associated muscular activities in patients with scapular dyskinesis. In addition, conscious control of the scapular orientation has been believed to improve scapular kinematics and muscle activation. Limited evidence showed the effect of conscious control in symptomatic patients with scapular dyskinesis. Research in Chapter 7 investigated the alteration of scapular kinematics and muscle activation after conscious control of scapula in patients with scapular dyskinesis. According to the findings in Chapter 7, assisted training devices such as real-time video feedback and modifying progressive control program may improve the effect of control in the task of arm elevation in erect position. Final research in Chapter 8 investigated the effect of progressive conscious control of scapular orientation on scapular movements and muscle activation during arm elevation in scapular plane with and without real-time video feedback in patients with subacromial impingement syndrome (SAIS) and medial border of scapula prominence. These chapters included the dimension of evaluation, pattern characteristics and intervention of scapular dyskinesis.

並列關鍵字

scapular dyskinesis ； pattern ； kinematics ； muscle activation ； evaluation ； intervention

參考文獻

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