01/11/2015
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AC en SC artrose: hoe revalideer je deze kleine gewrichtjes
40 – 60 jaar Bovenhandse activiteiten (sport) (direct) Trauma Geassocieerde schoudergordelpathologie
Vereecken Styn Lic. Kinesitherapie UZ-KUL
AC en SC artrose ....
AC en SC artrose .... •
Conventionele / conservatieve kinesitherapie: •
Conventionele / conservatieve kinesitherapie:
Manueel onderzoek en behandeling Manueel onderzoek AC
Oefentherapie
*close pack position: 90° abductie • Passieve horizontale flexie (adductie) en elevatie
• Shear test (antero-posterieure translatie)
• Scapula tractie (joint play)
• Clavicula translatie (ventro-dorsaal)
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AC en SC artrose .... •
Conventionele / conservatieve kinesitherapie:
Manuele behandeling AC
• •
• Scapula tractie
Aspecifiek Link naar glenohumerale mobiliteitsbeperking
• Scapula craniaal / clavicula caudaal
• Scapula caudaal / clavicula dorsaal
(anteflexie/abductie- elevatie beperking)
(Endorotatie beperking)
• Scapula ventrolateraal (horizontale flexie beperking)
• Clavicula ventrolateraal (Exorotatie beperking)
• Clavicula posteriorrotatie (Anterior rotatiestand)
AC en SC artrose ....
• Conventionele / conservatieve kinesitherapie:
• Clavicula anteriorrotatie
Manueel onderzoek SC
(Posterior rotatiestand)
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• Clavicula craniaal-caudaal & ventraal-dorsaal
• Clavicula tractie (joint play)
AC en SC artrose ....
• Clavicula dorsaal
• Conventionele / conservatieve kinesitherapie:
Manuele behandeling SC • •
• Clavicula caudaal
Aspecifiek Link naar glenohumerale mobiliteitsbeperking
• Clavicula caudaal – dorsaal (Abductie- elevatie beperking)
AC en SC artrose .... •
Conventionele / conservatieve kinesitherapie: Manueel onderzoek en behandeling
Oefentherapie
• Clavicula ventraal (Abductie- elevatie beperking)
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Mov02975.mpg
Cools, 2008
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01/11/2015
Top 5 Revalidatie richtlijnen (volgens klinische indicatie) • M trapezius pars ascendens • M serratus anterior
• Glenohumerale exorotatoren
• Lengte posterieure kapsel
• Posturale keten *Trainingsleer kracht : NM (biofeedback) tot plyometrie Revalidatietraining *Revalidatie
Revalidatie richtlijnen (volgens klinische indicatie) • M trapezius pars descendens
Conscious correction of scapular orientation in overhead athletes performing selected shoulder rehabilitation exercises: The effect on trapezius muscle activation measured by surface electromyography, JOSPT, jan 2013
Revalidatie richtlijnen (vervolg) Huang, H.Y. et al. (2013) EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement
• M serratus anterior
J Electromyogr Kinesiol Feb;23(1):267-74.
…EMG biofeedback improved the scapular muscular balance during training exercises
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Revalidatie richtlijnen (vervolg) • Glenohumerale exorotatoren • Posterieure kapsel
Revalidatie richtlijnen (vervolg) • Posturale keten • Kibler et al (2006) – Sports Med: 189-98 The role of core stability in athletic function The importance of function of the central core of the body for stabilisation and force generation in all sports activities is being increasingly recognised. 'Core stability' is seen as being pivotal for efficient biomechanical function to maximise force generation and minimise joint loads in all types of activities ranging from running to throwing. However, there is less clarity about what exactly constitutes 'the core', either anatomically or physiologically, and physical evaluation of core function is also variable. 'Core stability' is defined as the ability to control the position and motion of the trunk over the pelvis to allow optimum production, transfer and control of force and motion to the terminal segment in integrated athletic activities. Core muscle activity is best understood as the pre-programmed integration of local, single-joint muscles and multi-joint muscles to provide stability and produce motion. This results in proximal stability for distal mobility, a proximal to distal patterning of generation of force, and the creation of interactive moments that move and protect distal joints. Rehabilitation should include the restoring of the core itself, but also include the core as the base for extremity function.
Effect of the Scapula Reposition Test on Shoulder Impingement Symptoms and Elevation Strength in Overhead Athletes ANGELA R. TATE, PT, PhD1 • PHILIP MCCLURE, PT, PhD2 STEPHEN KAREHA, PT, DPT, ATC, CSCS3 • DOMINIC IRWIN, PT, DPT4
Kinetic chain influences on upper and lower trapezius muscle activation during eight variations of a scapular retraction exercise in overhead athletes Journal of Science and Medicine in Sport; 2013
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