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過頂揮臂運動員肩部傷害病變與改善方法

Shoulder Injury Schema and Rehabilitation Protocols for Overhead Throwing Athletes

摘要


運動過程中,需要過頂擺臂的運動員,諸如棒球投手、游泳選手、標槍等投擲型運動員,此類型的選手因常需要高速、高反覆次數的轉動盂肱關節,致使肩部常出現疼痛現象,檢查後常發現患有臨床病症,如:肩夾擠症候群、肩盂唇破裂、肩胛骨活動障礙等等。目前投擲肩部傷害機轉還在探討中,既有的研究證據顯示,過頂擺臂運動需要盂肱關節與肩胛骨活動緊密配合,兩者如唇齒相依互相影響缺一不可。倘若因長期投擲訓練使腹側肌群肌肉過於緊張、背側肌群缺乏足夠相對應的訓練而使肌力不足,肩部腹背側肌力失衡,產生肩胛骨失能的現象,將使得肱骨頭在盂肱關節內的旋轉中心位移,再加上異常之肩胛活動,往往造成肩關節活動受到限制,產生肩內旋不足症狀,並進一步導致肩袖損傷、肩夾擠症候群或盂唇撕裂等等的肩部傷害,這一系列的演進流程可能是造成過頂運動員肩部症狀的因素。本文蒐集過往對於肩關節傷害之研究,並將其彙整,目的在探討過頂投擲訓練對肩部損傷與功能障礙的可能發生原因,並提出肩關節損傷之演進流程並建立基模,同時給予較全面的檢傷與復健建議。本文結語指出若能將背側肌群強化、放鬆過緊的胸側肌群促進胸背肌群肌力平衡,同時強化旋轉肌袖肌力共同穩固肩胛活動,藉此改善或避免肩夾擠症候群、肩盂唇破裂等症狀的產生。

並列摘要


Athletes who engage in repetitive overhead motions are a unique subset of athletes that usually experience distinct shoulder injuries. The majority of athletes who present with throwing related injuries are baseball players, javelin throwers and swimmers. Those athletes engage in drills and game scenarios where overhead motions are made at high velocities, over long distances, and in a repetitive manner, all of which increase the strain on the glenohumeral (GH) joint. Movements of the upper arm require proper coordination of GH joint and scapular kinematics. Movements of GH joint and the scapula kinematics are inextricably linked, as each affects the other. Scapular dyskinesis alters scapular positioning and motion is found in association with most shoulder injuries. The most common causative mechanisms of scapular dyskinesis involve alterations in the soft tissues, whether in the form of inflexibility or intrinsic muscle pathology. There is evidence of scapular kinematic alterations associated with shoulder impingement, rotator cuff tendinopathy, rotator cuff tears, GH instability, adhesive capsulitis, and stiff shoulders. Scapular dyskinesis consequently increases the sprain on GH joint capsule and ligaments within, which dramatically affects GH joint range of motion. Range of motion deficits in shoulder external rotation (ER), internal rotation (IR), total rotation range of motion (ER + IR) were identified as glenohumeral internal rotation deficit (GIRD) and have been retrospectively associated with overhand athletes’ arm injuries. Multiple studies have postulated that GIRD is associated with undersurface rotator cuff tears, posterosuperior and anteriosuperior labral tears, and irreversible posterior capsular contracture. Several theories have been proposed to explain the pathogenesis of superior labral anterior posterior (SLAP) tears. Somehow, relationships between GIRD, scapular dysfunction and SLAP lesion were not well documented. Based on previous evidence collected, we hereby present a schema of shoulder injuries process from dorsal-ventral muscular imbalance to SLAP lesion or rotator cuff tears. Available evidence in clinical trials supports the use of therapeutic exercise in rehabilitating athletes suffering from shoulder pain. Therefore, the purpose of this paper was to provide recommended protocols for both acute phase treatment and subsequent rehabilitation. This paper concluded that with proper coordination of dorsal and ventral muscles, a shoulder girdle might further improve scapular kinematics. Improved scapular function may help to avoid several shoulder injuries such as impingement syndrome or SLAP lesion.

參考文獻


鄭世忠、張曉昀、陳百鍊、楊卿潔(2011)。棒球投手盂肱關節內旋活動度缺損:可能傷害機轉與預防之道。運動教練科學。24,1-12。
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被引用紀錄


陳恊聰、林春珍、曾韻珊(2020)。照護一位因運動傷害導致肩關節肩盂唇撕裂病人之手術全期護理志為護理-慈濟護理雜誌19(6),125-136。https://www.airitilibrary.com/Article/Detail?DocID=16831624-202012-202012300015-202012300015-125-136

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