The Influence of Repetitive Dorsal Glide Mobilization on the Translational Movement of the Head of Humerus-A Preliminary Study Using Fresh Cadavers

肩肱關節重複性背向鬆動術對肱骨頭部移動程度之影響－先驅研究報告

徐阿田(Ar-Tyan Hsu) ； 林純彬(Chun-Pin Lin)

《物理治療》 28卷2期 (2003/04) Pp. 55-64

摘要

目的：本研究之目的為以新鮮肩部樣本為模式以研究肩肱關節重複性背向鬆動術對肱骨頭部移動程度之影響。方法：本研究共使用了五個新鮮肩部樣本（年齡平均64.0±1.1歲），樣本經解剖除去軟組織，但留存接近肩關節之棘上肌及其肌腱，以確保肩關節囊不至於受到無意之破壞。本研究使用一雙軸材料試驗機來模擬治療師施行肩肱關節背向鬆動術（力量為80牛頓、施行時間為10秒鐘），總共重複施行15次。施行背向鬆動術之位置為外展40度與外展盡端之位置。作者以肱骨頭部之前後位移量為量測之變數。結果：第一、五、十、十五次施力時之前後位移量在外展40度時分別為(Mean±SD) 17.7+8.3 mm、19.1±8.4 mm、19.5±8.4 mm、19.8±8.4 mm，在外展盡端時為5.5±5.0 mm、6.8±5.5 mm、7.3±5.8 mm與7.6±5.9 mm。前後位移量在外展40度時大於在外展盡端時之位移量(ANOVA with repeated measures, F=43.218, p=.003)，在外展40度時前十次的重複動作中前五次所產生之位移增加量彼此間有不同之傾向，其P值介於0.018與0.047之間。在外展盡端之位置時前十次的重複動作中第三至第五次所產生之位移增加量彼此間有顯著之不同，其P值介於0.006與0.003之間。其第一至第三次所產生之位移增加量彼此間亦有不同之傾向，其P值同為0.044。結論：本研究顯示為獲得適當之效果，鬆動術或伸張運動應至少重複5次以上。

關鍵字

關節鬆動術 ； 肩部 ； 重複 ； 移動

並列摘要

Purposes: To investigate the effect of a repetitive dorsal glide procedure of the glenohumeral joint on the magnitude of anterior-posterior displacement (APD) of the head of the humerus. Methods: Five fresh cadaver shoulder specimens were used. The mean age at the time of death was 64.0±1.1 years (Mean ± SD). Specimens were dissected free of soft tissues except for the lateral portions of the rotator cuff muscles (and tendons) to ensure intact glenohumeral joint capsules. A biaxial material testing system (MTS) equipped with an X-Y table w as used to provide glenohumeral dorsal gliding force (80 N for 10 seconds) through an adapter attached to the piston rod of its actuator. Fifteen repetitions of dorsal glide procedures were performed at the resting position (APR) first, and then at the end range (APE) of abduction. The magnitude of APD of the head of the humerus was recorded as the main outcome measure. Results: The APD values at the 1st, 5th, 10th and 15th repetitions of APR were (Mean ± SD) 17.7±8.3 mm, 19.1±8.4 mm, 19.5±8.4 mm, and 19.8±8.4 mm, respectively, and those of the APE were 5.5±5.0 mm, 6.8±5.5 mm, 7.3±5.8mm and 7.6±5.9 mm, respectively. There are significant effects of joint position (ANOVA with repeated measures, F=43.218, p=0.003) and repetition (F=18.999, p=0.0005) on the values of APD. At the resting position, post hoc contrast showed that the first 4 adjacent pairs had a tendency of difference in APD magnitude with p values ranging from 0.018 to 0.047. At the end range, the 3rd and 4th comparisons were significantly different (p=0.006 and p=0.003) and there was a tendency toward difference in the first two pair of comparisons (p=0.044 and p=0.044). No interaction was noted between repetition and joint position. Conclusions: The findings of the present study suggest that the capsular restraint to APD is greater at end range than that of the resting position and at least 5 repetitions are needed to acquire the optimal effect of mobilization or stretching under conditions employed by the present study. Generalization of the findings of this study to living patient population should proceed with care as the age of the cadaver, tissue temperature, removal of periarticular muscles are known to cause changes in joint mechanical properties.

並列關鍵字

Joint mobilization ； Shoulder ； Repetition ； Translation