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kapita selekta 3 Shoulder Injuries in Sport.ppt

kulliah pengantar untuk rehabilitasi cedera bahu

Health & Medicine◦
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Most athletic shoulder injuries are due to one of two mechanisms: 1.Repetitive overhead activity (microtrauma)  throwing 2.A significant force (macrotrauma) applied to the shoulder complex.
Ligamentous structures of the shoulder girdle
Passive Mechanisms  Bony  Glenoid labrum  Intraarticular pressure  Joint cohesion  Glenohumeral capsule  Glenohumeral ligaments Active Mechanisms Joint compression Dynamic ligament Tension Neuromuscular control Scapulothoracic joint
Dynamic Stabilizers of the Shoulder : Neuromuscular control Primary Stabilizers •Rotator cuff muscles (supraspinatus,infraspinatus, teres minor, subscapularis) •Deltoid •Long head of the biceps brachii Secondary Stabilizers •Teres major •Latissimi dorsi •Pectoralis major The Static Stabilizers : Bony Geometry  glenohumeral joint
Anatomic view of the glenoid cavity with its surrounding structures
Phase I: Acute Phase Goals: • Diminish pain and inflammation • Normalize or improve motion and flexibility • Retard muscular atrophy • Enhance dynamic stabilization Phase II: Intermediate Phase Goals: • Improve muscular strength and endurance • Maintain or improve flexibility • Promote concentric-eccentric muscular training • Maintain dynamic stabilization Phase III: Advanced Phase Goals: • Initiate sport-specific training • Enhance power and speed (plyometrics) • Maintain a rotator cuff strengthening program • Improve muscular endurance Phase IV: Return-to-sport Phase Goals: • Gradually return to sports activities • Maintain gains in strength, power, endurance, and flexibility
 Impingement of the rotator cuff may occur in some athletes  baseball players, quarterbacks, swimmers, and others whose activities involve repetitive use of the arm at or above 90° of shoulder abduction.  Matsen  defined impingement as encroachment of the acromion, coracoacromial ligament, coracoid process, or acromioclavicular joint on the rotator cuff mechanism, which passes beneath them as the glenohumeral joint is moved  in flexion and IR.  Impingement usually involves the supraspinatus tendon
• Rotator cuff impingement is a self-perpetuating process. • Matsen noted the following:  muscle or cuff tendon weakness causes impingement from loss of the humeral head stabilizing function, which leads leading to tendon damage, disuse atrophy, and additional cuff weakness;  bursal thickening causes impingement as a result of subacromial crowding, which produces greater thickening of the bursa; and  posterior capsular tightness can lead to impingement, disuse, and stiffness because the tight capsule forces the humeral head to rise up against the acromion.
 Numerous factors, both structural and functional, contribute to impingement, especially in young athletes.  Additionally, if the capsule is especially lax and if the dynamic stabilizers are not sufficient, the humeral head may displace anterosuperiorly and lead to complaints of impingement.  The goal in treating athletes with impingement syndrome, either nonoperatively or surgically, is to reduce compression and friction between the rotator cuff and subacromial space.
• Shape of the coracoacromial arch, which allows passage of the adjacent rotator cuff mechanism • Normal undersurface of the acromioclavicular joint • Normal bursa • Normal function of the humeral head stabilizers (rotator cuff) • Normal capsular laxity • Smooth upper surface of the rotator cuff mechanism • Normal function of the scapular stabilizers
 Acute impingement syndrome  time, rest from noxious stimuli, nonsteroidal antiinflammatory drugs, local modalities (e.g., cold, heat, and electrical stimulation), and a general shoulder rehabilitation program of flexibility and a PRE program
• The supraspinatus helps stabilize the head of the humerus against upward pull of the deltoid. A. Subacromial impingement is prevented by normal cuff function. B. Deep surface tearing of the supraspinatus weakens the ability of the cuff to hold the humeral head down, thereby resulting in impingement of the tendon against the acromion. B
• Subacromial impingement  a chronic inflammatory process produced by one of the rotator cuff muscles and the subdeltoid bursa "pinching" against the coracoacromial ligament and/or anterior acromion when the arm is raised above the head. • The supraspinatus portion of the rotator cuff is the most common area of impingement. • This four-phase program can be used for conservative management of impingement. • The protocol is designed to attain maximal function in minimal time.
 Posterior shoulder impingement.  This occurs when the arm is abducted and externally rotated; the supraspinatus and infraspinatus muscles impinge (rub) on the posterosuperior rim of the glenoid cavity, which leads to fraying of the cuff or labrum.
 Rehabilitation of shoulder injuries should concentrate on developing dynamic joint stability.  Athletes who are susceptible to pathologic shoulder conditions should participate in an off- season shoulder flexibility and rotator cuff strengthening program to help prevent shoulder problems, and they should continue this stretching and strengthening program two or three times weekly during the season.
 Preventive and postinjury exercises that strengthen the rotator cuff muscles should be performed to dynamically stabilize the glenohumeral joint and the scapular stabilizers that help orient the glenoid fossa with the humeral head to maintain stability.  Weakness of the scapula stabilizers can predispose the athlete to a variety of pathologic shoulder conditions.
• After shoulder surgery or injury, emphasis should be placed on addressing the inflammation process and restoring motion. • After initiation of a rotator cuff strengthening program, PNF techniques may be implemented to help restore neuromuscular control. • In the late phases of rehabilitation, eccentric, isokinetic, and plyometric exercises may be initiated. • In the advanced strengthening phase, the goals of the program are to initiate sport-specific types of training for the shoulder joint complex.
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