terça-feira, 7 de abril de 2009

ARTIGO DO MÊS (14/2009)

Radiographic analysis of commonly prescribed scapular exercises
Cote, M.P.; Gomlinski, G.; Tracy, J.; Mazzocca, A.D.
J Shoulder Elbow Surg (2009) 18, 311-316


Hypothesis: The performance of scapular exercises in the context of a clinical model of fatigue will result in superior migration of the humeral head and alterations in shoulder kinematics on radiographic analysis.

Materials and methods: Six healthy male volunteers underwent a series of radiographs before and immediately following two scapular exercises. Prone shoulder horizontal abduction with the arm in external rotation and an overheadarm raise in line with the fibers of the lower trapezius havebeen advocated as optimal exercises for scapular musclestrengthening.
The purpose of this study is to evaluate theeffect of these two exercises on shoulder kinematics.
To reproduce a practice setting a clinical model of muscle fatigue was utilized. Radiographs were taken at various degrees of elevation. Glenohumeral angle (GA), scapulothoracic angle (SA), and the position of the humeral head on the glenoid (excursion) were measured on each radiograph. Two-tailed paired sample t-test were used to compare pre-fatigue to post fatigue measures.

Results: Following fatigue there was a significant increase in excursion at 45, 90, and 135 degrees of elevation indicating superior migration of the humeral head. There was an increase in SA from 0 to 45 degrees and a decrease inGA from 45 to 90 degrees of elevation. From 90 to 135 degrees an increase in GAwas observed.

Discussion: The amount of superior migration of the humeral head observed following exercise was consistent with previously reported amounts of superior migration in patients with subacromial impingement. The alterations that occurred in shoulder kinematics following exercise may have resulted from parascapular muscle fatigue as well as rotator cuff muscle insufficiency.

Conclusion: In the context of a clinical model of fatigue, these scapular exercises resulted in superior migration of the humeral head and alterations in shoulder kinematics on radiographic analysis in healthy subjects.

Level of evidence: Basic science study.

Keywords: Scapular exercise; radiographic analysis; physical therapy; subacromial impingement.

Qualquer selecção de exercícios e/ou actividades a implementar num programa de Fisioterapia para disfunções do complexo articular do ombro, deve ser acompanhada por uma avaliação funcional para se compreender o impacto que os mesmos têm na cinemática normal do ombro. O Ritmo escapulo-umeral é um bom indicador clínico dessa função.
Por outro lado os exercícios ou actividades escolhidas devem ser feitos num contexto funcional.
Raul Oliveira, Fisioterapeuta

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