肩胛運動異常與相關肩膀疾患：介入與療效

Scapular Dyskinesis and Related Shoulder Injuries: Intervention and Effectiveness

黃崇舜(Tsun-Shun Huang) ； 林居正(Jiu-Jenq Lin)

《物理治療》 45卷4期 (2020/12) Pp. 251-270

https://doi.org/10.6215/FJPT.202012_45(4).0002

摘要

本文目的為探討肩胛運動異常之運動與徒手介入方法與療效。肩胛運動異常的介入策略需要依據臨床評估的結果來決定，以軟組織延展度問題與肌肉表現問題為主要介入目標。肩胛區域軟組織緊縮的介入以胸小肌和肩關節後側軟組織的伸展運動和徒手治療最為常見。肌肉表現問題的介入主要分成3個階段：（1）在肩胛訓練早期，透過肩胛知覺控制提高個案對肩胛位置的本體感覺與恢復正常肩胛位置；（2）當個案能妥善控制肩胛骨位置後，下個階段會進展到日常生活動作能進行肩胛骨動態控制與肌肉活化。根據個案功能性需求教導開放鏈和閉鎖鏈肩胛運動；（3）最後階段會進展到針對過肩運動或功能特定動作進行肩胛肌力耐力訓練並整合動力鏈動作進入進階運動計畫。探討短期肩胛介入計畫對疼痛、肩膀功能、肩胛運動學與其它肩胛相關量測的文獻日趨增加。文獻結果顯示針對肩胛區域軟組織緊縮或肌肉表現問題或合併進行短期介入後會有疼痛減少與功能改善，但肩胛運動學的改變結果具有爭議。未來仍需要更多研究釐清肩膀疼痛與功能和肩胛動作改變之間的關係。

關鍵字

肩胛運動異常 ； 肩膀疾患 ； 介入 ； 運動 ； 運動學

並列摘要

The purpose of this study was to investigate the exercise and manual intervention and the effectiveness in patients with scapular dyskinesis. The intervention strategies for scapular dyskinesis depend on the findings of clinical evaluation. The flexibility of soft tissue and muscle performance are the main targets for the scapular intervention. The intervention of pectoralis minor and posterior shoulder tightness are the most common parts in restoring the flexibility of soft tissue. On the other hand, there are three stages of treating scapular muscle performance problems. (1) In the early stage of scapular training, conscious control of the scapula is necessary to improve scapular proprioception and normalize resting scapular position. (2) In the next stage, the clients can progress to scapular dynamic control and muscle activation in daily activities after controlling resting scapular position appropriately. The therapists teach open chain and close chain scapular exercises based on the client's functional requirements. (3) In the final stage, the clients can progress to strength and endurance training during sport-specific or function-specific movements and integrate kinetic chain into advanced exercise programs. More evidence has emerged to investigate the effect of a short-term scapular intervention program on pain, shoulder function, scapular kinematics, and other scapular-related measurements. The evidence showed pain reduction and function improvement after the short-term scapular intervention program. However, there were conficting results in scapular kinematics. The relationships between shoulder pain and function and altered scapular kinematics need to be clarified in future studies.

並列關鍵字

Scapular dyskinesis ； Shoulder injuries ； Intervention ； Exercise ； Kinematics