biomecanica y rehabiitacion del hombro

8/13/2019 Biomecanica y Rehabiitacion Del Hombro

http://slidepdf.com/reader/full/biomecanica-y-rehabiitacion-del-hombro 1/16

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



BIOMECANICA DEL GOLPE-LANZAMIENTO


BIOMECANICA DEL GOLPE-LANZAMIENTO

Shoulder In3uries in the Thro9ing Athlete! J Bone Joint Surg Am. ())=! 'B'S! SeppBraun# 5irk &okmeyer and >eter '! Millett

PATOMECANICA


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




ROM


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



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-:!



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



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 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=(*!



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



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



EVALUACIÓN SICK EVALUACIÓN SICK

EVALUACIONES ESTATICAS EVALUACIONES ESTATICAS



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



OBJETIVOS DOLOR

•+isioterapia

•Tcnicas manuales

FORTALECIMIENTO Y ESTABILIDAD

•ona media

•>eriescapulares

•6stabiliKadores primarios

•6stabiliKadores secundarios•Miembros inferiores



FLEXIBILIZACION EVITAR



CONCLUSIONES

• 6aluar

• 6stabiliKar escapula

• ona media "adena cinematica

• 6longaciEn capsula

• +ortalecimiento estabiliKadores primarios ysecundarios

Lic. Andrés Romañuk

[email protected]

MUCHAS GRACIAS

biomecanica y rehabiitacion del hombro

Documents