Cinematica Escapular - Rodrigo Jordan
Cinematica Escapular - Rodrigo Jordan
Cinematica Escapular - Rodrigo Jordan
Resumen
La escpula posee variados roles con el fin de mantener una funcin adecuada
del complejo de cintura escapular. La escpula rota sincrnicamente durante el
movimiento del hmero, acta como una base estable para la activacin del
manguito rotador y funciona como un eslabn en la cadena cintica. La
presencia de lesin o disfuncin del sistema artromusculoesqueltico, as como
la debilidad y/o prdida de la flexibilidad muscular pueden alterar las funciones
de la escpula y la posicin de reposo y/o el movimiento escapular dinmico.
Las alteraciones ms frecuentes de la cinemtica escapular han sido
denominadas aleteo escapular, diskinesis y disritmia escapular, las cuales
estn presentes en un gran nmero de las lesiones de hombro y en alrededor
de un 18% de los sujetos asintomticos. La cinemtica escapular disfuncional
es una respuesta inespecfica a una condicin dolorosa de hombro. La
presencia de una cinemtica escapular disfuncional puede ser determinada
durante el examen clnico a travs de la inspeccin visual de la posicin de la
escpula en reposo y durante los movimientos de elevacin y descenso del
brazo, junto con la realizacin de mediciones objetivas posturales y maniobras
correctivas escapulares, las cuales ayudaran al clnico a determinar el grado en
que la escpula puede estar implicada en la lesin de hombro.
I. Cinemtica Escapular
Por otro lado, tanto la posicin y/o movimiento escapular anormal han sido
llamados en forma de consenso como: aleteo escapular, diskinesia escapular,
diskinesis escapular o disritmia escapular18, 20-22
Dado que son muchos los factores que pueden influir en el desarrollo de un
movimiento y/o posicin escapular alterada, es ms adecuado utilizar el
trmino diskinesis por ser ms inclusivo.22
A B
C D
Figura 2. A. Muestra diskinesis tipo I. Observe la prominencia del ngulo escapular infero medial. B. Diskinesis tipo II.
Observe la prominencia de todo el borde escapular medial. C. Diskinesis tipo III. Observe la prominencia y ascenso del
borde escapular superior. D. Diskinesis tipo IV. Observe el acoplamiento de la escpula en la pared torcica durante la
fase de descenso del brazo.
Adicionalmente, la disfuncin de la cinemtica escapular tambin ha sido
descrita comodisritmia escapular,22 la cual puede manifestarse tanto en la fase
de ascenso o descenso de elevacin del brazo. Se entiende por disritmia
escapular cualquier movimiento de ascenso o descenso prematuro, rpida
rotacin inferior, encogimiento o resalte en la cinemtica escapular durante los
movimientos de elevacin y/o descenso del brazo, en cualquier plano de
elevacin.21, 22(Figura 3)
*
*
Este dficit en la activacin del serrato anterior ha sido asociado a una menor
inclinacin posterior y rotacin superior escapular y a una menor rotacin
externa escapular en el rango final de elevacin glenohumeral, favoreciendo la
rotacin interna e inferior escapular. Por su parte, la inhibicin y el retardo del
tiempo de activacin del trapecio inferior esta clnicamente asociado a un
aumento del aleteo escapular durante la elevacin del brazo, ya un mayor
riesgo de pellizcamiento subacromial al disminuir la capacidad de elevacin del
acromion y de la inclinacin posterior escapular la que contribuye a aumentar el
espacio subacromial durante la elevacin del brazo. 39 La disminucin de
lainclinacin posterior y rotacin superior escapular favorecen el desarrollo de
diskinesis escapular.
Discusin
Conclusin
El comprender los mecanismos neuromecnicosque pueden generar, mantener
y perpetuar una patrn cinemtico escapular alterado nos permitir poder
desarrollar las estrategias motoras de correccin escapular que favorezcan una
ptima cinemtica escapular, interviniendo en la gnesis de la disfuncin y no
en las consecuencias clnicas, disminuyendo los factores de riego de las
lesiones de hombro.
Bibliografa.
1. Badley EM, Tennant A. Changingprofile of jointdisorderswithage:
findingsfrom a postal survey of population of calderdale, West Yorkshire,
UnitedKingdom. Ann RheumatologyDis. 1992; 366-371.
2. Winters JC, Sobel JS, groenier KH, Arendzen JH, Meyboon-deJong B.
Thelong-termcourse of shouldercomplaints: a prospectivestudy in
general practice. Rheumatology 1999; 38; 160-16.
3. Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R et al.
Prevalence and incidence Ifadultsconsultingforshoulderconditions in UK
primarycare; patterns of diagnosis and referral. Rheumatology 2006; 45;
215-221.
4. Ludewig PM, Reynolds J. Theassociation of scapularkinematics and
glenohumeral jointpathologies. J Orthop Sport PhysTher 2009;39:90-
104.
5. VoightML, Thomson BC. The role of thescapula in therehabilitation of
shoulder injuries. J Athletic Training. 2000;35(3):364-372.
6. Kibler WB. Role of thescapula in theoverheadthrowingmotion.
ContempOrthop. 1991;22:525-532.
7. Michener LA, McClure PW, Kanduna Ar. Anatomical and
biomechanicalmechanisms of subacromial impingement sndrome.
ClinBiomech2003; 18; 369-379.
8. Ludewig PM, Cook TM, Nawoczenski DA. Three-dimensional
scapularorientation and muscleactivity at selected positions of humeral
elevation. J Orthop Sport PhysTher. 1996;24:57-65.
9. Lukasiewicz, Ac., McClure, P., Michener,L., Pratt, N., Sennett,
B.Comparison of three-dimensional scapular position and orientation
between subjectswith and withoutshoulder impingement. J of Orthop and
Sport PhysTher 1999; 29; 574-583.
10. McClure, PW., Michener, L., Sennett, BJ., Karduna, Ar. Direct 3-
dimensional measurement of
scapularkinematicsduringdynamicmovements in vivo. J.
ShoulderElbowSurg. 2001; 10; 269-277.
11. Ludewig PM, Braman JP. Shoulder impingement:
Biomechanicalconsiderations in rehabilitation. ManTher 2011; 16; 33-39.
12. Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, and
LaPrade RF. Motion of theshouldercomplexduringmultiplanar humeral
elevation.J. BoneJointSurg Am. 2009; 91; 378-389.
13. Ludewig PM, Hassett D, LaPrade RF, Camargo P, and Braman JP.
Comparison of scapular local coordinatesystems. ClinBiomech (Briston ,
Avon) 2010;25(5):415-421.
14. Kibler WB. The role of thescapula in athleticshoulderfunction. Am J Sport
Med. 1998;26(2):325-337.
15. Paine RM, Voight ML. The role of thescapula. J Orthop Sport PhysTher.
1993;18:386-391.
16. Sahrmann S. Diagnosis and treatment of
movementimpairmentsyndromes. St Louis, MO: Mosby; 2002.
17. Comerford M and Mottran S. Kinetic control. Themanagement of
uncontrolledmovement. Churchill Livingstone, Australia, 2012
18. Kibler WB, Sciascia A, Wilkes T. Scapulardyskinesis and its relation
oshoulderinjury. J Am AcadOrthopSurg. 2012;20:364-372.
19. Inman Vt, Saunders JB, Abbott LC. Observations of thefunction of
theshoulder. ClinOrthopRelat Res 1996;330:3-13.
20. Kibler WB, Sciascia A. Currentconcepts: ScapularDyskinesis. Br J Sport
Med. 2010;44:300-305.
21. Kibler WB, Ludewig PM, McClure PW, Uhl T, Sciascia A. Scapular
Summit 2009. Introduction, J Orthop Sport PhysTher. 2009;39 (11):A1-
A11.
22. Kibler WB, Ludewig PM, McClure PW, et al. Clinicalimplications of
scapulardyskinesis in shoulderinjury: The 2013
consensusstatementfromthe scapular Summit. Br J Sport Med. 2013;1-
12
23. Kuhn JE, Plancher KD, Hawkins RJ. ScapularWinging. J Am
AcadOrthopSci. 2001;6:3-10.
24. Meininger A, Figuerres, Goldberg B. Scapularwinging. J Am
AcadOrthopSurg. 2011;19:453-462.
25. Martin R and Fish D. Scapularwinging: anatomicalreview, diagnosis, and
treatments. CurrRevMusculoskeletMed 2008;1:1-11.
26. Warner JJP, Micheli LJ, Arslanian LE et al. Scapulothoracicmotion in
normal shoulders and shoulderswith glenohumeral inestability and
impingement syndrome. ClinOrthopRelat Res 1992;285:199
27. Kibler WB, Uhl T, Maddux J, Brooks P,Zeller B and McMullen J.
Quantitativeclinicalevaluation of scapulardysfunction: a reliabilitystudy. J
ShoulderElbowSurg. 2002;11:550-556.
28. Cools AM, Truyf F, De Mey K, Maenhout A, Castelein B, Cagnie B:
Rehabilitation of scapulardyskinesis: fromthe office workertothe elite
overheadathlete. Br J Sport Med 2013; 1-8.
29. Ellenbecker T and Cools A. Rehabilitation of shoulder impingement
syndrome and rotatorcuff injuries: anevidence-basedreview. Br. J Sport
Med 2010; 44; 319-327.
30. Struyf F, Nijs J, Mollekens S et al. Scapular-focusedtreatment in
patientswithshoulder impingement syndrome: a randomized clinical trial.
ClinRheumatol 2013;32:73-85.
31. Borstad JD, Ludewig PM. Theeffect of long versus short
pectoralisminorrestinglenghtonscapularkinematics in healthyindividuals. J
Orthop Sport PhysTher. 2005;35:227-238.
32. Burkhart SS, Morgan CD, Kibler WB: Thedisabledthrowingshoulder:
spectrum of pathologypart III: The SICK scapular, scapulardyskinesis,
thekineticchain, and rehabilitation. Arthroscopy 2003;19:641-661
33. Kibler WB, Sciascia AD, Thomas SJ. Glenohumeral
internalrotationdeficit: pathogenesis and response toacutethrowing. Sport
MedArthroscRev 2012;20: 34-38.
34. Kibler WB, Sciascia AD, Uhl TL, et al. Electromyographicanalysis of
specificexercisesforscapular control in earlyphases of
shoulderrehabilitation. Am J Sport Med 2008;36:1789-1798.
35. Cools AM, Dewitte V, Lanszweert F et al. Rehabilitation of
scapularmuscle balance. Am J Sport Med 2007;35:1744-1751.
36. Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement
syndrome and rotatorcuff injuries: anevidence-basedreview. Br J Sport
Med 2010; 44:319-327.
37. Tsun-ShunHuang, Han-YiHuang, Tyng-Guey Wang, Yung-ShenTsai, Jiu-
JenqLin. Comprehensiveclassification test of scapulardyskinesis: A
reliabilitystudy. ManTher 2014; 1-6
38. Worsley P, Warner M, Mottram S et al. Motor control
retrainingexercisesforshoulder impingement effectsonfunction,
muscleactivation, and biomechanics in youngadults. J
ShoulderElbowSurg 2013;22:11-19.
39. Phadke V and Ludewig P. Study of thescapularmusclelatency and
deactivation time in peoplewith and withoutshoulder impingement. J
Electromyog and Kinesiol2012; 1-7.
40. De May K, Danneels L, Cagnie B, et al. Consciouscorrection of
scapularorientation in
overheadathletesperformingselectedshoulderrehabilitationexercises:
theeffectontrapezius mucle
activationmeasuredbysurfaceelectromyography. J Orthop Sport
PhysTher 2013;43:3-10.
41. Blasier R, Guldberg R, Rothman E. Anterior shoulderstability:
contributions of therotatorcuffforces and the capsular ligaments in a
cadavermodel. J of Shoulder and ElbowSurgery 1992; 1 (3); 140-150.
42. Heyworth BE and Williams RJ. Internal impingement of shoulder. Am J
Sport Med 2009;37:5:1024-1037
43. McClure PW, Tate AR, Kareha S et al. A
clinicalmethodforidentifyingscapulardyskinesis, part 1: reliability. J Athl
Train 2009;44:160-164.
44. Tate A, McClure PW, Kareha S et al. A
clinicalmethodfordefiningscapulardyskinesis, part 2: validity. J Athl Train
2009;44:165-173
45. Uhl TL, Kibler BW, Gecewich B, et al. Evaluation of
clinicalassessmentmethodforscapulardyskinesis. Arthroscopy
2009;25:1240-1248.
46. Ellenbecker TS, Bibler WB, Baile DS, Caplinder R, Davies GJ, and
Riemann B. Reliability of scapularclassification in examination of
profesional baseballplayers. ClinOrthopRelat Res 2012;470:1540-1544.
47. Hickey BW. Accuracy and reliability of observationalmotionanalysis in
identifyingshouldersymptoms. ManTher. 2007;12(3):263-270.
48. Ebaugh DD, Spinelli BA. Scapulothoracicmotion and
muscleactivityduringtheraising and loweringphases of
anoverheadreachingtask. J of Electromyog and Kinesiol 2010;20: 199-
205
49. Wassinger C, Sole G, Osborne H. The role of experimentally-induced
subacromial painonshoulderstrength and throwingaccuracy. ManTher
2012;17:411-415.
50. Sole G, Osborne, Wassinger C. Electromyographic response of
shouldermuscletoacute experimental subacromial pain. ManTher.
2014;19: 343-348.
51. Reddy AS Mohr KJ, Pink MM, Jobe FW. Electromyographicanalysis of
thedeltoid and rotatorcuffmuscle in personswith subacromial
impingement. J ShoulderElbowSurg 2000;9: 519-523.
52. Scibek JS, Mell AG, Downie BK, Carpenter JE, Hughes RE.
Shoulderkinematics in patientswith full-thicknessrotatorcufftearsafter a
subacromial injection. J ShoulderElbowSurg, 2008;17 (1): 172-181.
53. Lund JP, Donga R, Widmer CG, Stahler CS. Thepain-adaptationmodel: a
discussion of therelationshipbetweenchronicmusculoskeletalpain and
motor activity. Cn J PhysiolPharmacol 1991;69:683-694.
54. Tucket K, Hodges P. Motoneuronerecruitmentisalteredwithpaininduced in
non-muscular tissue. Pain 2009;38.151-155.
55. Hodges PW. Pain and motor control.: Fromthelaboratorytorehabilitation.
J Electromyog and Kinesiol 2011; 21: 220-228.
56. Tsao H, Galea MO, Hodges PW. Reorganization of the motor corte xis
associatedwith postural control dficits in recurrentlow back pain. Brain
2008;131: 2161-2171.
57. Wright A, Wassinger C, Frank M et al.Diagnosticaccuracy of
scapularphysicalexamination test forshoulderdisorders: a
systematicreview. Br J Sport Med. 2013;47(14):886-892.
58. Cools AM, Dewitte V, Lanszweert K, et al. Rehabilitation of
scapularmuscle balance: whichexercisesto prescribe? Am J Sport Med
2007;35:1744-51.
59. Van de velde A, De Mey K, Maenhout A et al. Scapular-
musclepeformance: two training programs in adolescentswimmers. J Athl
Train 2011;46:160-167.
60. Merolla G, De SE, Campi F et al. Supraspinatus and
infraspinatusweakness in overheadathleteswithscapular diskinesis:
strengthassessmentbefore and afterrestoration of scapularmusculature
balance. MusculoskeletSurg 2010;94:119-125
61. Merolla G, De SE, Sperlling JW et al.
Infraspinatusstregthasssessmentbefore and
afterscapularmusclerehabilitation in
prfessionalvolleyballplayerswithscapular diskinesis. J
ShoulderElbowSurg 2010;19:1256-1264.
62. De Mey K, Dannels L, Cagnie B, et al.
Scapularmusclerehabilitationexercises in overheadathleteswith
impingement symptoms: effect of a 6-week training programo n
musclerecruitment and functionaloutcome. A, J Sport Med 2012;40:1906-
1915.