Changes in Shoulder External Rotator Muscle Activity during Shoulder External Rotation in Various Arm Positions in the Sagittal Plane

[Purpose] The aim of this study was to investigate changes in electromyographic (EMG) activity of the infraspinatus and posterior deltoid muscles during shoulder external rotation under different shoulder flexion angles. [Subjects] Thirteen participants were included in this study. [Methods] The participants performed isometric shoulder external rotation at 45°, 90°, and 135° of shoulder flexion. A surface EMG system recorded the EMG activity of the infraspinatus and posterior deltoid muscles during shoulder external rotation. The changes in the muscle activity of infraspinatus and posterior deltoid and ratio of infraspinatus to posterior deltoid muscle activity were analyzed using one-way repeated-measures analysis of variance with Bonferroni’s correction. [Results] The posterior deltoid activity was significantly decreased, while the ratio of the infraspinatus to posterior deltoid activity was significantly increased at 45° of shoulder flexion compared with 90° and 135° of shoulder flexion (p < 0.05). There were no significant differences in the EMG activity of the infraspinatus among the three conditions (p > 0.05). [Conclusion] These findings indicate that shoulder external rotation at 45° of shoulder flexion effectively reduced the contribution of the posterior deltoid activation to shoulder external rotation.Key words: Infraspinatus, Posterior deltoid, Shoulder external rotation     

关节松动术治疗脑卒中后肩痛的临床研究

目的 探讨脑卒中后肩痛的治疗方法.方法 采用关节松动术对脑卒中后肩痛患者的肩部进行治疗,用简式McGill疼痛问卷和Fugl-Meyer上肢功能评分在治疗前和治疗后30 d进行评定.结果 治疗组疼痛评分明显低于对照组(P<0.01),治疗组上肢功能评分明显高于对照组(P<0.01).结论 对脑卒中偏瘫患者肩痛进行关节松动治疗可明显减轻了肩痛并有效提高了上肢的运动功能.     

The Effect of Shoulder Mobilization on Scapular and Shoulder Muscle Activity During Resisted Shoulder Abduction: A Crossover Study of Asymptomatic Individuals

ObjectiveThe primary aim was to investigate the effect of inferior shoulder mobilization on scapular and shoulder muscle activity during resisted shoulder abduction in asymptomatic individuals.MethodsThis was a lab-based, repeated-measures, crossover, randomized controlled study. Twenty-two participants were recruited. The order of experimental conditions was randomized. Each participant performed 5 repetitions of resisted shoulder abduction before and after the control and mobilization (grade +IV inferior shoulder mobilization, 3 sets, 60 seconds) conditions. Surface electromyography recorded the muscle activity of anterior, middle, and posterior deltoid; supraspinatus; infraspinatus; upper and lower trapezius; serratus anterior; and latissimus dorsi muscles.ResultsMuscle activity levels reduced for infraspinatus (11.3% MVIC, 95% CI: 1.7-20.8), middle (22.4% MVIC, 95% CI: 15.9-28.8) and posterior deltoid (8.7 % MVIC, 95% CI: 4.6-12.9), and serratus anterior (-28.1% MVIC, 95% CI: 15.6-40.8) muscles after the mobilization condition during the eccentric phase of shoulder abduction. No carryover effects were observed, and within-session reliability was excellent (intraclass correlation coefficient scores ranging from 0.94 to 0.99).ConclusionOur findings suggest that inferior glenohumeral mobilization reduces activity levels of some scapular and shoulder muscles. Given the exploratory nature of our study, changes in muscle activity levels may have been found by chance. Confirmatory studies are required.     

The Immediate Effect of Neuromuscular Joint Facilitation (NJF) Treatment on Hip Muscle Strength

[Purpose] This study investigated the change in hip muscle strength of younger persons after neuromuscular joint facilitation (NJF) treatment. [Subjects] The subjects were 45 healthy young people, who were divided into two groups: a NJF group and a proprioceptive neuromuscular facilitation (PNF) group. The NJF group consisted of 21 subjects (11 males, 10 females), and the PNF group consisted of 24 subjects (11 males, 13 females). [Methods] Participants in the NJF group received NJF treatment. We measured the maximal flexor strength and the maximal extensor strength during isokinetic movement of the hip joint before and after intervention in both groups. The angular velocities used were 60°/sec and 180°/sec. [Results] The NJF group showed significant increases in the maximal flexor strength and the maximal extensor strength after the intervention at each angular velocity. In the PNF group, the maximal flexor strength of 60°/sec and the maximal extensor strength of 180°/sec were significant increases. [Conclusion] These results suggest that there is an immediate effect of NJF intervention on hip muscle strength.Key words: Neuromuscular joint facilitation, Hip muscle strength     

Concentric Internal and Eccentric External Fatigue Resistanc of the Shoulder Rotator Muscles in Female Tennis Players

Background

Shoulder muscle imbalance is a potential shoulder injury risk factor in athletes performing overhead sports. While normative functional peak strength of concentric external to concentric internal shoulder muscle fatigue data is available, comparisons of functional eccentric external to concentric internal shoulder rotator muscle fatigue resistance, which impacts muscle imbalance throughout the duration of play, have not been studied in this population.

Objectives

To assess fatigue resistance of the internal and external shoulder rotator muscles in female tennis players.

Methods

Fifteen female collegiate tennis players were tested bilaterally for shoulder concentric internal and eccentric external peak torque production throughout 20 maximal repetitions on a Kin-Com isokinetic dynamometer. Twelve t - tests were conducted to evaluate for differences in peak torque, relative fatigue ratios, and functional peak torque ratios between extremities and mode of activation during the first, as well as, last five repetitions that were conducted.

Results

Non-dominant concentric internal and eccentric external peak torque production significantly decreased throughout the twenty repetitions. Neither dominant concentric internal peak torque decrements and eccentric peak torque decrements were not significantly different across the twenty contractions.These changes in peak torque upon subsequent repetitions resulted in relative fatigue ratios of dominant eccentric external rotation that were significantly greater than non-dominant eccentric external rotation. Relative fatigue ratios of dominant concentric internal rotation did not differ from non-dominant concentric internal rotation.

Conclusions

The data suggest that eccentrically activated external shoulder rotator muscles could possibly adapt to overhead activities by becoming more fatigue resistant.     

Effects of Tibiofibular and Ankle Joint Manipulation on Hip Strength and Muscle Activation

ObjectivesThe purpose of this study was to determine whether high-velocity, low-amplitude ankle region manipulations could increase force output and muscle activation of hip musculature in individuals with a history of ankle sprain and unilateral tensor fascia latae (TFL) weakness during muscle testing.MethodsThis investigation used a single-arm repeated measures design. Twenty-five participants’ force outputs were tested at three time points (before manipulation, immediately after manipulation, and 48 hours after manipulation), and muscle activation of the rectus femoris, gluteus medius, and TFL was measured before and immediately after manipulation. Manipulations were applied to the talocrural, subtalar, proximal, and distal tibiofibular joints of the weaker limb. No contralateral manipulations were applied. Two-way repeated measures analysis of variance was used to compare maximal and average force production for each limb. In addition, paired t tests were used to compare muscle activation before and after manipulations.ResultsThere was a significant limb × time interaction. The involved limb average force increased from before manipulation (65.7 N) to 48 hours after manipulation (77.8 N; P = .014), maximal force increased (76.9 N) 48 hours after manipulation (87.8 N; P = .030), and gluteus medius activation increased (9.8% maximum, 12.2% average) immediately after manipulation. No significant differences were found in the uninvolved limb.ConclusionThe results of this study suggest that high-velocity, low-amplitude ankle region manipulations might improve hip abductor strength in individuals with a history of ankle sprain and unilateral weakness during a TFL muscle test.     

浮针灌注疗法联合关节松动术对脑卒中偏瘫肩痛的影响

目的:观察浮针灌注疗法联合关节松动术对脑卒中偏瘫肩痛的影响。方法:选取2019年2—12月在山东省立第三医院康复医学科住院治疗的脑卒中偏瘫肩痛患者90例,按随机数字表法分为对照组、浮针组和综合组,每组30例。对照组仅给予常规康复训练,包括良肢位摆放、预防二次损伤、主动或助动的功能锻炼、低频电刺激、上肢日常生活活动能力模拟训练等,25 min/次,1次/d,5次/周,持续治疗4周。浮针组在对照组基础上给予浮针灌注治疗,肩关节前部疼痛明显时,患肌一般在肘关节远心端5 cm处,肩关节中间或后侧疼痛明显时,患肌一般在三角肌后下缘附近;以患肌作为进针点,针尖朝向肩关节,针体刺入疏松结缔组织后进行弧形扫散,频率100次/min,每组扫散1 min,每次做3组;每组扫散后要求患者主动或助动活动肩关节10次,活动方向和范围以引起轻度疼痛为佳,留针24 h,2次/周,持续治疗4周。综合组在浮针组基础上给予肩关节松动治疗,25 min/次,1次/d,5次/周,肩关节松动治疗先以1~2级手法改善肩关节疼痛,再以3~4级手法松解粘连,包括沿长轴分离和牵拉肩关节以缓解疼痛,滑动以松解关节囊,摆动以维持和扩大关节活动度,采取达到而不超过痛点的原则,每种手法重复3~4次。于治疗前、治疗4周后,分别采用疼痛视觉模拟评分(VAS)评定肩关节疼痛程度,采用Fugl-Meyer运动功能评分量表(FMA)评定上肢运动功能,采用改良Barthel指数(MBI)评定日常生活活动能力,采用量角器测量患者肩关节被动关节活动度(PROM)。结果:治疗前,3组VAS评分、FMA评分、MBI评分和肩关节PROM比较,差异无统计学意义(P>0.05)。与治疗前比较,3组治疗4周后VAS评分明显降低,FMA评分、MBI评分和肩关节PROM均明显升高,差异均有统计学意义(P<0.05)。与对照组比较,浮针组和综合组的VAS评分明显降低,FMA评分、MBI评分和肩关节PROM均明显升高,差异均有统计学意义(P<0.05)。与浮针组比较,综合组VAS评分明显更低,FMA、MBI评分和肩关节PROM均明显更高,差异均有统计学意义(P<0.05)。结论:浮针灌注疗法联合关节松动术能有效减轻脑卒中后偏瘫肩痛,改善上肢运动功能和日常生活活动能力,值得临床推广。     

Immediate Effect of Grade IV Inferior Hip Joint Mobilization on Hip Abductor Torque: A Pilot Study

Joint mobilization and manipulation stimulate mechanoreceptors, which may influence the joint and surrounding muscles. The purpose of this pilot study was to determine the effect of grade IV inferior hip joint mobilization on hip abductor torque. Thirty healthy subjects were randomly assigned to a control group (grade I inferior hip joint mobilization) or an experimental group (grade IV inferior hip joint mobilization). Subjects performed a pre- and post-intervention test of five isometric repetitions on the Cybex Normö dynamometer; the average torque was determined for both pre- and post-intervention measurements. These data were analyzed using the independent samples t-test with the significance level set at P<0.05. The results showed a statistically significant difference between the two groups for an increase in hip abductor torque in the experimental group (P=0.03). The experimental group demonstrated a 17.35% increase in average torque whereas the control group demonstrated a 3.68% decrease in average torque. These findings are consistent with other studies demonstrating that the use of grade IV non-thrust mobilization improves strength immediately post-intervention in healthy individuals. The results of this pilot study provide physical therapists with further support for the utilization of manual therapy in conjunction with therapeutic exercise to enhance muscle strength.Key Words: Arthrokinetic Reflex, Hip Abductors, Hip Joint, Isometric Torque, Manual Therapy, Non-Thrust Mobilization, Muscle StrengthThe hip joint is a ball-and-socket joint composed of the acetabulum and femur^{1, 2}. The hip has strong muscular support, with the gluteus medius functioning as an important stabilizer with a main function of hip abduction. The anterior portion of this muscle also assists in the secondary function of internal rotation^{1, 3}, and the posterior portion of the gluteus medius assists in external rotation of the hip⁴. The gluteus medius functions to stabilize the hip at mid-stance of gait in the coronal plane; it provides lateral pelvic stabilization at terminal stance^{5 – 7}. Compromise in hip abductor muscle function can lead to a Trendelenburg gait pattern, described as a contralateral pelvic drop during stance phase. This may be compensated for by an upper body shift toward the involved side to maintain the center of gravity over the affected hip^{1, 8}; the contralateral quadratus lumborum then compensates by pulling the pelvis superiorly⁹ or the lumbar spine may compensate with ipsilateral lateral trunk flexion¹⁰.The hip abductors transfer forces from the lower extremity to the spine, explaining their frequent involvement in patients with spinal complaints^{9, 11 – 13}. Beckman and Buchanan¹⁴ demonstrated differences in the firing and strength of the hip abductor muscles in the presence of distal lower extremity involvement. Studies have shown that chronic ankle instability was associated with delayed firing of the hip abductor muscles^{9, 14, 15}. Further studies have correlated weakness with isokinetic testing of hip abductor and adductor muscles with ankle and foot injuries^{16, 17}. Friel et al¹⁸ demonstrated a correlation between chronic ankle sprains and ipsilateral hip abductor weakness. Powers¹⁹ described the influence of altered lower extremity kinematics on the patellofemoral joint by identifying two possible mechanisms leading to patellofemoral pain: femoral rotation and knee valgus. Increased femoral internal rotation—as might be caused by gluteus medius weakness—results in an increased Q-angle. Powers et al²⁰ demonstrated that this femoral rotation was the primary contributor to patellar tilts and displacements. Using pressure-sensitive film, these authors reported that 30° of femoral internal rotation significantly increased patellofemoral stress (force per unit) when the knee was flexed beyond 30°. Hip abductor weakness can also lead to valgus at the knee during dynamic tasks. Knee valgus also leads to an increase in the Q-angle, displacing the patella laterally with respect to the patellar groove of the distal femur. Excessive pronation is the end result of tibial abduction, as it compensates for femoral adduction.Joints influence motor unit activation and, therefore, muscle function. The capability of a joint to alter muscle function is mediated by the articular receptors; the articular receptors can inhibit or facilitate muscle tone²¹. In this paper, the term arthrokinetic reflex is used to refer to the tonic and phasic reflex neuromuscular activity, both facilitating and inhibiting, emanating primarily from the Type I and II articular mechanoreceptors^{21, 22}.The Guide to Physical Therapist Practice ²³ has defined mobilization and manipulation as synonymous terms describing a manual therapy technique comprising a continuum of skilled passive movements to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small-amplitude/high-velocity therapeutic movement. During mobilization/manipulation, the capsuloligamentous tissues of a joint are mechanically stretched²¹. One primary goal of mobilization is to improve extensibility of restricted capsuloligamentous tissue; secondarily, articular mechanoreceptor activation level is affected. Joint mobilization has been demonstrated to improve physiologic and accessory motions to hypomobile structures²⁴. This in turn causes an alteration in the articular mechanoreceptor resulting by way of arthrokinetic reflex activity in enhanced muscle strength^{21, 22}. These arthrokinetic reflex actions have been hypothesized to occur through the down-regulation of inhibitory input on motor unit activity^{21, 22}. Joint mobilization not only has an impact on the motor unit activity in muscles functioning over the joint, but it also has been shown to affect more remote muscles as well, including muscles on the contralateral side of the body²². Herzog et al²⁴ demonstrated that distracting cervical facet joints stimulated the articular mechanoreceptors exerting significant coordinated reflexogenic influences on the activity of the neck and limb musculature. Cibulka²⁵ performed mobilization to a dysfunctional sacroiliac joint and restored the normal length-tension relationship of the hamstrings, thereby increasing the main torque produced. Liebler et al²⁶ demonstrated a significant increase in lower trapezius strength with the utilization of grade IV spinal mobilization: The Cybex Norm® dynamometer recorded a 6% increase in lower trapezius strength in the experimental group as compared to a 0.2% increase in the control group. Cleland et al²⁷ similarly demonstrated improved lower trapezius strength in response to manipulative treatment of the lower thoracic spine (T6-12) using grade V thrust techniques; they reported a statistically significant increase (P<0.01) in peak strength of 14.5% for the experimental group versus 3.9% for the control group. Yerys et al²⁸ demonstrated a significant effect of grade IV mobilization on gluteus maximus strength; the experimental group demonstrated a 14% increase in strength as compared to a 4% increase in the control group. As in the present study, both Liebler et al²⁶ and Yerys et al²⁸ applied a grade IV non-thrust mobilization to the subjects in the experimental group and a grade I to those in the control group.The above studies highlight the role of the joint capsule and its reflexogenic influence on muscles. Failure to recognize the importance of these arthrokinetic reflex circuits may explain the difficulty in neuromuscular re-education and strengthening of muscle groups. This in turn leads to failure of an exercise regime to achieve the desired results with regard to improved muscle function²⁹. Many rehabilitation programs focus on strengthening exercises using resistance regimens; however, few focus on the actual quality and control of movement. Manual techniques may effectively be used in cases of muscle imbalances, which are a form of dysfunction. Bookhout²⁹ suggested that greater success in rehabilitation might be achieved through the use of manual techniques, either before or in conjunction with resistive exercises.Mobilizing a restricted joint may increase muscular strength by removing the reflexogenic inhibition emanating from the joint mechanoreceptors^{21, 22, 24, 26, 29}. For example, a mechanical hip joint disorder associated with ipsilateral adductor muscle contracture, inferior capsuloligamentous hypomobility, and gluteus medius weakness, especially of the posterior fibers³⁰, will theoretically impose inhibitory neural input on the gluteus medius while simultaneously imposing reflex facilitation on the adductor muscles each time that the hip abducts against its restrictive barrier of motion^{21, 22}. This may lead to further functional destabilization of the hip joint. Above we discussed the important role of the gluteus medius muscle not only at the hip but also in the entire lower extremity and in the spine. Considering this important role of the gluteus medius muscle and the information on arthrokinetic reflex circuits discussed above, the research hypothesis in this pilot study is that grade IV inferior hip joint mobilization performed at the end of abduction will result in an immediate increase in hip abductor torque when compared to a grade I inferior hip joint mobilization.     

Professional Baseball Player Type and Geographic Region of Origin Impacts Shoulder External and Internal Rotation Strength

BackgroundShoulder strength deficits are implicated in arm injuries and performance deficits in baseball players.PurposeTo characterize shoulder external (ER) and internal (IR) rotation strength in professional baseball players, and compare strength across player type (pitchers, position players) and geographic origin (North America, Latin America).Study DesignCross-sectional.MethodsMinor league professional baseball players from North America and Latin America (n=242; age=22.4±2.3 years; n=135 pitchers and n=107 position players; n=162 North American and n=80 Latin American players) volunteered at spring training. Bilateral shoulder IR and ER isometric strength was measured in sitting with the arm at the side using a handheld dynamometer stabilized on a wall via a specialized jig. Strength was normalized to body weight, and compared using t-tests between player type and geographic area of origin (p < 0.05).ResultsPosition players had greater strength in ER, IR and ER:IR (ER:0.7-2.7N/kg; IR:1.3-3.8N/kg; ER:IR ratio 0.36-1.22) compared to pitchers (ER:0.5-2.5N/kg; IR:0.6- 4.2N/kg; ER:IR ratio 0.44-1.16) on the throwing arm. North American pitchers had lower ER [MD= -0.4 (95%CI:-0.7,-0.2);p=0.002] and IR [MD= -0.2 (95%CI:-0.4,-0.1);p=0.006] than Latin American pitchers on the throwing arm. There were no differences between geographic groups for position players.Discussion/ConclusionsPlayer position and geographic origin influence shoulder rotational strength values in professional baseball players. Position players have 14 – 20% higher ER and IR isometric strength than pitchers. Moreover, Latin American pitchers exhibited 11.8% greater ER strength and 16.7% greater IR strength as compared to North American pitchers. Normative values can be used to determine player deficits, declines in performance, and targets for return to play after injury.Level of EvidenceLevel II     

局部痛点注射加关节松动手法治疗肩周炎

运用局部痛点注射加关节松动术治疗肩周炎２８例。结果：治愈１２例,显效１４例,好转２例,治愈显效率９２．８６％,与且比较有显著性。而且疗程一比较碾 显著性。提示局部痛点注射加关节松动手法治疗肩周炎疗程短、疗效高。     

创伤性肩袖损伤患者术后不同时间开始康复训练效果观察

目的探讨创伤性肩袖损伤关节镜术后患者术后不同时间开始早期康复锻炼对肩关节功能恢复的影响,分析相关原因,为统一康复训练实施时间提供依据。方法将2006年9月—2008年11月收治的59例创伤性肩袖损伤关节镜术后患者按入院先后顺序随机分为观察组29例和对照组30例。两组患者术后均采用常规的抗炎、消肿、银杏叶针活血及短波、低频脉冲治疗;均于术后0～6周采用肩关节制动功能锻炼。观察组同时于术后第1天始按创伤性肩袖损伤术后康复计划进行肩关节康复训练,对照组按传统保守方法于术后第6周开始进行肩关节康复训练,均采用Constant-Murley肩关节评分标准评价患肩的功能状况。结果除术后第4周两组疼痛、日常生活活动差异无统计学意义(P>0.05)外,术后第8周、第12周、第16周、第20周观察组疼痛、日常生活活动、肩关节活动度及肌力均优于对照组(P<0.05或P<0.01)。结论创伤性肩袖损伤患者关节镜术后,在无痛原则下,肩关节的功能锻炼越早进行效果越好。     

Effect of Resistance Training Maintaining the Joint Angle-torque Profile Using a Haptic-based Machine on Shoulder Internal and External Rotation

[Purpose] The aim of this study was to present an individualized resistance training method to enable exercise while maintaining an exercise load that is set according to an individual’s joint angle-torque using a haptic-based resistance training machine. [Methods] Five participants (machine group) performed individualized shoulder internal and external rotation training with a haptic resistance training machine, while another five participants performed general dumbbell-based shoulder internal and external rotation training for eight weeks. Internal and external rotation powers of subjects were measured using an isokinetic machine before and after training. [Results] The average powers of both shoulder internal and external rotation has been improved after training (25.72%, 13.62%). The improvement in power of external rotation in the machine group was significantly higher than that in the control group. [Conclusion] This study proposes a haptic-based individualized rotator cuff muscle training method. The training protocol maintaining the joint angle-torque profile showed better improvement of shoulder internal/external rotation than dumbbell training.Key words: Rotator cuff, Haptic machine     

Changes in Passive Mechanical Properties of the Gastrocnemius Muscle at the Muscle Fascicle and Joint Levels in Stroke Survivors

Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.

Objectives

To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.

Design

To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.

Setting

Research laboratory in a rehabilitation hospital.

Participants

Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).

Interventions

Not applicable.

Main Outcome Measurements

At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.

Results

At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).

Conclusions

This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation.     

肢体肌力的变化对急性缺血性脑卒中患者吞咽障碍的预测价值

目的探讨肢体肌力的变化对急性缺血性脑卒中患者吞咽障碍的预测价值,旨在快速识别急性缺血性脑卒中后吞咽障碍的发生和变化.方法便利抽样法连续选择2018年1月至2019年3月某医院收治的急性缺血性脑卒中患者235例,分析肢体肌力与吞咽障碍的相关性,并绘制受试者工作特征曲线(ROC曲线),计算肢体肌力预测吞咽障碍的临界值.结果急性缺血性脑卒中后吞咽障碍的发生率为37.87%(89/235),不同肢体肌力患者吞咽障碍的发生率差异有统计学意义(P<0.05);肢体肌力与吞咽障碍呈负相关(r=-0.654,P<0.05),肢体肌力预测吞咽障碍的ROC曲线下面积为0.848,灵敏度为0.893,特异度为0.742,最佳界值为3.5,P<0.05.结论肢体肌力的变化对急性缺血性脑卒中患者吞咽障碍有一定的预测价值,当一侧肢体肌力小于4级时,应当警惕吞咽障碍的发生,及时优化此类患者的护理.     

后关节囊重建及外旋肌群修补预防全髋关节置换术或人工股骨头置换术后关节后脱位

目的探讨后关节囊重建及外旋肌修补对全髋关节置换术或人工股骨头置换术后关节后脱位的影响。方法以经后侧入路行初次全髋关节置换术或人工股骨头置换术患者65例作为A组,术中将后方关节囊及外旋肌群经数个骨孔固定于股骨大转子后方的骨质上。以经后侧手术入路、仅修补外旋肌群患者65例作为B组,术中后关节囊进行切除,外展角在30°～55°,前倾角在10°～20°,均使用防脱位内衬。并比较2组患者术后关节后脱位情况。结果2组患者术后随访3～24个月。A组患者术后关节后脱位1例(1.54%)。B组患者术后关节后脱位6例(9.23%),其中1例连续2次关节后脱位。A组患者术后关节后脱位发生率明显低于B组(P<0.05)。结论后关节囊及外旋肌群与股骨大转子之间的完整性重建有助于降低初次行后入路全髋关节置换术或人工股骨头置换术后关节后脱位的发生率。     

The Effects of Elbow Joint Angle Changes on Elbow Flexor and Extensor Muscle Strength and Activation

[Purpose] This research investigated the relationship between elbow joint angle and elbow flexor and extensor strength and activation, taking into consideration the length-tension tension curve of the muscle. [Subjects] There were 30 research subjects in total, 15 male and 15 female college students from Busan S University who had no functional disabilities that might affect measurement of muscle strength and muscle activation, and none had they experienced any damage in their upper extremities or hands. [Methods] The elbow joint angles were positioned at angles of 56°, 70° and 84°, and then muscle strength and activation were compared. Repeated measures ANOVA was used for statistical analysis, and the paired t-test was used to identify the difference between each angle. We used the SPSS for windows (ver. 21.0) statistical software and a significance level of α=0.05. [Results] The results showed that muscle strength and activation of the biceps was highest when the joint was placed at 56°. On the other hand, for the triceps, the result was highest when the joint angle was placed at 84°. [Conclusion] The tests confirmed that muscle strength and activation were highest at the joint angle at which the muscle was stretched to 20% more than the resting position in concentric contraction.Key words: Joint angle, Muscle strength, Muscle activation     

半肩关节置换术对老年肱骨近端骨折患者关节活动度及预后的影响

目的探究半肩关节置换术对老年肱骨近端骨折患者关节活动度及预后的影响。方法将本院2011年2月~2013年3月收治的79例老年肱骨近端骨折患者纳入研究对象行回顾性分析。根据手术类型的不同分为锁定钢板内固定组(44例)与半肩关节置换组(35例)。比较两组手术指标、手术前、术后3个月肩关节活动度及术后1年内并发症情况。结果半肩关节置换组的手术时间为98.67±16.49min,显著低于内固定组107.23±14.68min(P0.05),两组术中出血量及住院天数差异均无统计学意义(P0.05);半肩关节置换组术后3个月时肩关节屈曲、外展、内旋、外旋活动度分别为121.46±24.51°、115.42±21.82°、69.51±8.59°、85.27±12.64°,均明显高于内固定组(P0.05)。术后1年内,半肩关节置换组发生1例术后感染,无假体松动、移位情况发生,总并发症发生率2.86%;内固定组1例骨折部位不愈合,2例肱骨头坏死,总发生率为6.81%。两组并发症发生率比较,差异均无统计学意义(字2=0.636,P0.05)。结论对老年肱骨近端骨折患者行办肩关节置换术,可明显增加其术后关节活动度,术后并发症少,治疗效果十分显著。