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NY VIDEN....KORTE RESUMEÉR AF NYE PUBLIKATIONER

Sep 2, 2014


Fra Dansk Sportsmedicin samlet af Anders F. Nedergaard, Jonathan Vela og Raja Sikandar Aziz. 

 

Skulder

Ann Cools et al fra Universitet i Ghent, Belgien, har skrevet en oversigtsartikel om rehabilitering af scapulær dyskinesi [2]. I artiklen beskriver hun hvordan forfattergruppen mener, at der er et væsentligt overlap imellem ætiologierne indenfor nakke og skulder områderne og at scapulær dyskinesi er et væsentlig element i begge typer problemstillinger, hvorefter de beskriver en række eksempler på dette overlap. De foreslår at man i behandlingen af skapulær dyskinesi betragter det som en kombination af nogle passive (fleksibilitet) og aktive (muskelaktivitet) egenskaber af musklerne omkring skulderbladet og præsenterer derefter en algoritme, som foreskriver hvilket typer behandling/fysioterapi patienten skal igennem. Det er i øvrigt den samme algoritme hun præsenterede på DIMS kongressen i 2014. I den sidste del af artiklen konkretiserer forfatterne så punkterne i algoritmen med hensyn til hvilke interventioner der er mest passende for.

I en anden ny artikel har Ann Cools et al undersøgt rehabiliteringsøvelser ved biceps lidelser og SLAP-læsioner [3], hvilket er sket ved at undersøge EMG aktiviteten hos 32 (16 mænd og 16 kvinder) raske forsøgspersoner i et deskriptivt studie. Disse skulle hver især udføre 16 almindeligt forekommende øvelser, der anvendes til overhåndsatleter med skuldersmerter.

I artiklen fremgår forskellige EMG aktivitetsresultater, som de bruger til at foreslå et gradueret øvelsesprogram i forbindelse med rehabiliteringen. Resultaterne viste bl.a. at 13 øvelser havde en lav EMG aktivitet i biceps brachii (BB), mens de restende 3 øvelser viste en moderat EMG aktivitet. Forfatterne påpeger selv, at de på intet tidspunkt når en høj EMG

aktivitet sv.t. >50% MVIC, hvorfor deres gradueret program kun er tiltænkt de tidlige og intermediate faser af rehabiliteringen, hvor det gælder om at beskytte sener og labrum.

Vi har talt med Ann Cools for at høre hvad hun mener er de vigtigste ting at drage frem fra de 2 artikler. Hun fortæller ”In the assessment and treatment of patients with chronic pain in the upper quadrant, clinicians very often are confronted with scapular dyskinesis, associated with shoulder or neck pain symptoms. Scapular malpositioning and muscle dysfunction have been identified in a wide variety of patients, from office workers with chronic neck- and arm pain to the elite overhead athlete with throwing- or smashing related shoulder pain. Although the cause-consequence relationship between both clinical findings is still unclear, there is a general consensus that scapular dysfunction should be objectively assessed, and decision-based treated. In general, both flexibility deficits as well as scapular muscle performance deficits may be detected. Depending on the clinical findings, the clinician should focus on restoring flexibility by stretching and restoring neuromuscular balance in the scapular muscles selecting the appropriate exercises. This paper intends to present a clinical reasoning algorithm guiding the clinician into the functional assessment as well as the treatment of scapula-related shoulder and neck problems.

In the past 20 years, superior labrum anterior-posterior (SLAP) lesions in the throwing shoulder have been a challenge to both clinicians and researchers. The diagnosis, biomechanical mechanism, as well as the conservative and surgical treatment have been a topic of discussion amongst health professionals, surgeons as well as rehabilitation specialists. Although rehabilitation exercises are recommended in the nonoperative and postoperative treatment of bicepsrelated disorders and SLAP lesions in overhead athletes, a progressive exercise protocol with controlled loads on the biceps has not yet been described. Therefore the purpose of this second study was to describe a continuum of exercises with progressive load on the biceps based on electromyographic (EMG) analysis. The results provide a continuum of exercises with an increasing level of EMG activity in the biceps. Exercises targeting the trapezius resulted in less loads on the biceps compared with exercises for the serratus anterior. In addition, exercises with an internal rotation component showed low activity in the biceps, whereas exercises with an elbow flexion/shoulder forward flexion component exhibited higher EMG levels in the biceps. These results may assist the clinician in the appropriate choice of exercises in a graded rehabilitation program of biceps-related injuries.

 

2. Cools AMJ et al. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. BrJ Sports Med. 2014;48(8):692–697.

3. Cools AM, Borms D, Cottens S, Himpe M, Meersdom S, Cagnie B. Rehabilitation Exercises for Athletes With Biceps Disorders and SLAP Lesions: A Continuum of Exercises With Increasing Loads on the Biceps. Am J Sports Med. 2014;42:(6)1315-1322.