Biomecanica y Rehabiitacion Del Hombro
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Transcript of Biomecanica y Rehabiitacion Del Hombro
8/13/2019 Biomecanica y Rehabiitacion Del Hombro
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BIOMECÁNICA Y REHABILITACIÓNDEL HOMBRO
Lic. Andrés Romañuk
CLASIFICACIÓN
• Atraumatic
• Multidireccional
• Bilateral
• Rehab
• Inferior capsular shift
• Traumatic
• Unidireccional
• Bankart
• Surgery¿?
INESTABILIDAD MENOR
AIOS
• Acquired
• Instability
• Oerstressed
• Shoulder Surgery
AMSI
• Atraumatic
• Minor
• Shoulder
• Instability
Minor shoulder instability! "astagna A# $ordenson U# %arofalo R# &arlsson '!Arthroscopy! ())* +eb, (- .(/, (0012!!
ESTABILIDAD-INESTABILIDAD
ESTABILIDAD-INESTABILIDAD
• "on3untamente entre 4igamentos# labrum ycapsula
• 5inamicamente Manguito rotador
• "orrecta mecanica escapular
6lectromyographic anlysisof the supraspinatus and deltoidmuscles during - commonrehabilitatione7ercises! Reinold MM# Macrina 4"# 8ilk &6# +leisig %S# 5un S# BarrentineS8#6llerbusch MT# Andre9s 'R! ' Athl Train! ())* Oct15ec,:(.:/;:<:1=!
THE KINETIC CHAIN
>athomechanics of the Thro9ing Shoulder! 8! Ben &ibler# M5? and Stephen '! Thomas#>h5# AT"9
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BIOMECANICA DEL GOLPE-LANZAMIENTO
>athomechanics of the Thro9ing Shoulder! 8! Ben &ibler# M5? and Stephen '! Thomas#>h5# AT"9
BIOMECANICA DEL GOLPE-LANZAMIENTO
Shoulder In3uries in the Thro9ing Athlete! J Bone Joint Surg Am. ())=! 'B'S! SeppBraun# 5irk &okmeyer and >eter '! Millett
PATOMECANICA
>athomechanics of the Thro9ing Shoulder! 8! Ben &ibler# M5? and Stephen '! Thomas#>h5# AT"9
CADENA LESIONADA?
• *(@ + rot! 67t infra y redondo
• :@ +le7ib lumbar# sit and reach 2cm
• ::@ trendelemburg C# mmii no dominante# squat a0pp cDestab pelica# step up and do9n a 0ppcDestab pelica!
• -=@ rot! Int mmii no dominante
"urrent"oncepts! The 5isabled Thro9ing Shoulder; Spectrum of >athology! >art III; TheSI"& Scapula# Scapular 5yskinesis# the &inetic "hain# and Rehabilitation! Stephen S!Burkhart# M!5!# "raig 5! Morgan# M!5!# and 8! Ben &ibler# M!5!
CAPSULA POSTERIOR CAPSULA ANTERIOR
Shoulder In3uries in the Thro9ing Athlete! J Bone Joint Surg Am. ())=! 'B'S! SeppBraun# 5irk &okmeyer and >eter '! Millett
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ROM
Shoulder In3uries in the Thro9ing Athlete! J Bone Joint Surg Am. ())=! 'B'S! SeppBraun# 5irk &okmeyer and >eter '! Millett
INESTABILIDAD
MR PATOLOGICO
• AlteraciEn cinematica y actiidad muscular
• Aumento traslaciEn humeral superior
• Abd! -)F1=)F# dism! 6M% infraesp y subescapular
%raichen G# Bonel G# StammbergerT # et al! Threedimensional analysis of the 9idth of thesubacromial space in healthy sub3ects and patients 9ith impingement syndrome! AJR
Am J Roentgenol. 0===,0*(;0)010)<!Gess SA# Richardson "# 5arnell R# +riis ># 4isle 5# Myers >! Timing of rotator cuff actiationduring shoulder e7ternal rotation in thro9ers 9ith and 9ithout symptoms of pain! JOrthop Sports Phys Ther. ())2,-2;0(1()! 3ospt!())2!(0-:>oppen $&# 8alker >S! +orces at the glenohumeral 3oint in abduction! Clin Orthop Relat
Res. 0=*,0<210*)!
INESTABILIDAD E HIPERLAXITUD
• Idem MR patologico! .HH subesc! RI# subesc! ysupra R6/
• Inestab! anterior# supra! -)1<)FAbd!
Brostrom 4A# &ronberg M# $emeth %! Muscle actiity during shoulder dislocation! Acta Orthop Scand. 0==,<);<-=1<:0!Illyes A# &iss RM! 6lectromyographicanalysis in patients 9ith multidirectional shoulder instability during pull# for9ardpunch# eleation and oerhead thro9! Knee Surg Sports Traumatol Arthrosc. ())*,02;<(: <-0!4abriola '6# 'olly'T# McMahon >'# 5ebskiR6! Actie stability of the glenohumeral 3oint decreases in the apprehensionposition! Clin Biomech (Bristol, Aon!. ()):,0=;)01)=!4abriola '6# 4ee TJ# 5ebski R6# McMahon>'! Stability and instability of the glenohumeral 3oint; the role of shouldermuscles! J Shoulder "l#o$ Surg.())2,0:;-(S1-S!Matias R# >ascoal A%! The unstable shoulder in arm eleation; a three1dimensional and electromyographicstudy insub3ects 9ith glenohumeralinstability! Clin Biomech (Bristol, Aon!. ())<,(0 Suppl 0;S2(12Santos M'# Belangero 85# Almeida %4! Theeffect of 3oint instability on latency and recruitment order of the shouldermuscles! J "lectromyogr Kinesiol. ())*,0*;0<*10*2!Ogston 'B# 4ude9ig >M! 5ifferencesin -1dimensional shoulder kinematics bet9een persons 9ithmultidirectional instabilityan d asymptomatic controls! Am J Sports %ed.
BIOMECÁNICA SUPRAESPINOSO
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BIOMECÁNICA
• 6mpty "an genera un ector mayor orientado asuperior
• 4a RI e7trema a disminuyendo el braKo depalanca del supra! a medida que aumenta la Abd!de ) a =)F# poniendolo en desenta3a mecanica ygenerando un stress de tensiEn# deriando encompensaciones
• AdemLs aumenta la TensiEn en caps! >osteroint! yMR .infraesp/# contribuyendo en Tilt ant!# RIescapular# y protracciEn
INFRAESPINOSO Y REDONDO MENOR
• H 6M% en R6 decub! 4at!
• R6 en plano escap! :2FAbd
• R6 prono =)Fabd
Reinold MM# 8ilk &6# +leisig %S# et al! 6lectromyographicanalysis of the rotator cuffand deltoid musculature during common shoulder e7ternal rotation e7ercises! JOrthop Sports Phys Ther. ()):,-:;-21-=:!
INFRAESPINOSO Y REDONDO MENOR INFRAESPINOSO Y REDONDO MENOR
INFRAESPINOSO Y REDONDO MENOR SUBESCAPULAR
• "ompresiEn glenohumeral# RI y estab! Anterior
• 5atos inconclusos subesc H 6M% RI a )F o =)F Abd#pero a =)FAbd# el pect y dorsal ancho 6M%
• HH 6M% subesc! >ush up plus# dynamic hug y act!6M% Ne3erc! diagonal!
5ecker M'# Tokish 'M# 6llis GB# TorryMR# Ga9kins R'! Subscapularis muscleactiity during selected rehabilitation e7ercises! Am J Sports %ed.())-,-0;0(<10-:!
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SUBESCAPULAR SUBESCAPULAR
SERRATO ANTERIOR
• Importante en rotaciEn superior# tilt posterior yrotaciEn e7terna
• Acelera la escapula en la fase de lanKamiento.Nthro9ing/
• 6stabiliKa el borde medial y ang! Inf escapular.pre! 8inging/ y tilt anterior
• =)Fabd RI o R6 ayuda a estab! escapula
4ude9ig >M# "ook TM# $a9ocKenski 5A! Threedimensionalscapular orientation and muscle actiity atselected positions of humeral eleation! J Orthop Sports Phys Ther. 0==<,(:;2*1<2!Mc"lure >8# Michener4A# Sennett B'# &arduna AR! 5irect -1dimensional measurement of scapular kinematicsduring dynamic moements in io! J Shoulder "l#o$ Surg.
SERRATO ANTERIOR
• H act! push up plus pared# HH >ush up plus derodillas# HHH push up plus standard#
• >lus; protracciEn escap! despues de e7tens!completa de codos
• - e3ercicios HHH 6M%# push up plus# dynamic hug ypunch .piPa/
4ude9ig >M# Goff MS# Oso9ski66# Meschke SA# Rundquist >'! Relatie balance of serratusanterior and upper trapeKius muscle actiity during push1up e7ercises! Am J Sports %ed.()):,-(;::1:=-!5ecker M'# Gintermeister RA# +aber &'# Ga9kins R'! Serratus anterior muscle actiity during
! , ; 1 !
SERRATO ANTERIOR SERRATO ANTERIOR
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SERRATO ANTERIOR
• 63ercicio 8all slide .desliKar/# pacientes describenmenos dolor durante realiK!
• """
• "ompresiEn contra glenoides 1 estabilidQ
• >ara primeras fasesQ
Gard9ick 5G# Beebe 'A# Mc5onnell M&# 4ang "6! A comparison of serratus anteriormuscle actiation during a 9all slide e7ercise and other traditional e7ercises! JOrthop Sports PhysTher
SERRATO ANTERIOR
SERRATO ANTERIOR SERRATO ANTERIOR
SERRATO ANTERIOR SERRATO ANTERIOR
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SERRATO ANTERIOR TRAPECIO
• UT# rotaciEn superior y eleaciEn
• MT# retracciEn
• 4T# rotaciEn superior y depresiEn# contribuye tiltpost! y R6
4ude9ig >M# "ook TM# $a9ocKenski 5A! Threedimensionalscapular orientation and muscleactiity at selected positions of humeral eleation! J OrthopSports Phys Ther. 0==<,(:;2*1<2!4ude9ig >M# "ook TM! Alterations in shoulder kinematics and associated muscle actiity inpeople 9ith symptoms of shoulder impingement! PhysTher. ())),);(*<1(=0!%raichen G# Bonel G# Stammberger T# et al! Threedimensional analysis of the 9idth of thesubacromial space in healthy sub3ects and patients 9ith impingementsyndrome! AJR Am JRoentgenol.0===,0*(;0)010)<!
TRAPECIO MEDIO
• Relatiamente alta acti! con encogimiento hombro#remo prono y abd! >rono horiKont! a =)F y 0()F
Moseley 'B# 'r!# 'obe +8# >ink M# >erry '# Tibone '! 6M% analysis of the scapular muscles duringa shoulder rehabilitation program! Am J Sports %ed. 0==(,();0(10-:!6kstrom RA# 5onatelli RA# Soderberg %4! Surface electromyographic analysis of e7ercises for thetrapeKius and serratus anterior muscles! J OrthopSports Phys Ther. ())-,--;(:*1(2!
TRAPECIO MEDIO
TRAPECIO MEDIO TRAPECIO BAJO
• Relatiamente alta act! en remo prono# Abd!GoriKontal prono a =)F y 0-2F con R6 y RI# >$+ relo3escapular# remo alto parado# abd! 6scapular#fle7iEn y Abd! entre )F10()F con R6!
6kstrom RA# 5onatelli RA# Soderberg %4! Surface electromyographicanalysis of e7ercises for thetrapeKius and serratus anterior muscles! J OrthopSports Phys Ther. ())-,--;(:*1(2!Moseley 'B# 'r!# 'obe +8# >ink M# >erry '# Tibone '! 6M% analysis of the scapular muscles duringa shoulder rehabilitation program! Am J Sports %ed. 0==(,();0(10-:!Myers 'B# >asquale MR# 4audner &%# Sell T"# Bradley '># 4ephart SM! On1the1field resistancetubing e7ercises for thro9ers; an electromyographicanalysis! J Athl Train.())2,:);021((!Smith '# 5ahm 54# &aufman &R# et al! 6lectromyographic actiity in the immobiliKed shouldergirdle musculature during scapulothoracic e7ercises! Arch Phys %ed Reha#il. ())<,*;=(-1=(*!
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TRAPECIO BAJO TRAPECIO BAJO
TRAPECIO BAJO
• R6 bilateral Abd! )F me3or ratio entre UT14T
• Buen ratio# R6 decub! 4at! y Abd! GoriKontal prono a=)F y 0-2F con R6
Mc"abe RA! Surface electromyographic analysis of the lo9er trapeKius muscle during e7ercisesperformed belo9 ninety degrees of shoulder eleation in healthysub3ects! & Am J Sports Phys Ther. ())*,(;-:1:-!"ools AM# 5e9itte# 4ansK9eert +# et al! Rehabilitation of scapular muscle balance; 9hiche7ercises to prescribeQ Am J Sports %ed. ())*,-2;0*::10*20!
TRAPECIO BAJO
TRAPECIO BAJO EVALUAR
• 5iskinesia y capsula posterior .%IR5/
• >osturaDdesequilibrios musculares
• +uerKa
• "ontrol plico y lumbar
• %esto biomecLnico
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DISKINESIA - SICK
• Scapular malposition
• Inferior medial border prominence
•"oracoid pain and malposition
•5ys&inesis of scapular moement
The Role of the Scapula in Athletic Shoulder+unction! Am! '! Sports Med! 0==, (<, -(2 8!Ben &ibler
DISKINESIA - SICK
TIPOS DE DISKINESIA
• Tipo I# prominencia borde escapular inferomedial
• Tipo II# prominencia borde escapular medialcompleto
• Tipo III# prominencia borde superomedial
"urrent "oncepts! The5isabled Thro9ing Shoulder; Spectrum of >athology! >art III; TheSI"& Scapula# Scapular 5yskinesis# the &inetic "hain# and Rehabilitation! Stephen S!Burkhart# M!5!# "raig 5! Morgan# M!5!# and 8! Ben &ibler# M!5!
TIPOS DE DISKINESIA
EVALUACIÓN SICK
• Tipo sick
• 4ateral Scapular Slide Test .4SST/
• Test retracciEn y asistencia escapular
• Test Mc"lure .dinLmico/
The Role of the Scapula in Athletic Shoulder+unction! Am! '! Sports Med! 0==, (<, -(2 8!Ben &ibler
EVALUACIÓN SICK
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EVALUACIÓN SICK EVALUACIÓN SICK
EVALUACIONES ESTATICAS EVALUACIONES ESTATICAS
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EVALUAR CAPSULA POSTERIOR
EVALUAR CONTROL PELVICO
The 5isabled Thro9ing Shoulder; Spectrum of >athology >art III; The SI"& Scapula# Scapular5yskinesis# the &inetic "hain# and Rehabilitation Stephen S! Burkhart# M!5!# "raig 5!Morgan# M!5!# and 8! Ben &ibler# M!5!
EVALUAR CONTROL LUMBAR
The 5isabled Thro9ing Shoulder; Spectrum of >athology >art III; The SI"& Scapula# Scapular5yskinesis# the &inetic "hain# and Rehabilitation Stephen S! Burkhart# M!5!# "raig 5!Morgan# M!5!# and 8! Ben &ibler# M!5!
EVALUACIÓN GESTO DEPORTIVO EVALUACIÓN GESTO DEPORTIVO
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OBJETIVOS DOLOR
•+isioterapia
•Tcnicas manuales
FORTALECIMIENTO Y ESTABILIDAD
•ona media
•>eriescapulares
•6stabiliKadores primarios
•6stabiliKadores secundarios•Miembros inferiores
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FLEXIBILIZACION EVITAR
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CONCLUSIONES
• 6aluar
• 6stabiliKar escapula
• ona media "adena cinematica
• 6longaciEn capsula
• +ortalecimiento estabiliKadores primarios ysecundarios
Lic. Andrés Romañuk
MUCHAS GRACIAS