Microsoft PowerPoint - 박진영

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1 GLAD 병변 Glenoid Labral Articular Disruption -삼성박석민 한화장성호, 나란히수술대올라 < 스포츠월드 > 입력 시즌막판이미수술을결정한상태였던박석민은 10월 25일건국대병원에서팔꿈치뼛조각을제거하는수술을먼저받는다. 한화의베테랑내야수장성호는어깨수술을받아내년 5월에나그라운드로복귀할전망이다. 지난해 6월 KIA에서한화로이적했지만구단의기대에미치지못했다. 좌타자인장성호는타석에서헛스윙할때어깨통증이심했지만이를참고시즌을마쳤다. 사흘전건국대병원에서오른쪽어깨연골봉합수술을받았다. 복귀후 15경기연속출루행진을이어갈정도로꾸준하다. 특히 5월 9경기에서홈런 3개를터뜨리며허약했던중심타선에무게를실어주고있다. 어깨불안정성 Shoulder Instability 어깨불안정성 Shoulder Instability Anterior instability Dead arm syndrome Catching Load and shift drawer test Apprehension test / Relocation test Bankart lesion / Hill-Sachs lesion Posterior instability Multidirectional instability (MDI) 어깨강직 ( 동결견 ) Shoulder Stiffness( Frozen Shoulder ) 1

2 어깨강직 ( 동결견 ) Shoulder Stiffness( Frozen Shoulder ) Adhesive capsulitis Lt : Rt = 1.3 : 1 Woman : Man = 1.3 : 1 Common in DM pt Self limiting Arthroscopic capsulectomy & ROM exercise 쇄골골절 Fracture of the Clavicle 쇄골골절 Fracture of the Clavicle 쇄골골절 Fracture of the Clavicle Common sports injury 팔을밖으로펴서떨어질때 어깨로떨어질때 직접적인충격 Mid 1/3 fracture In adult : more than two-thirds of clavicle fractures In children : up to 90% of clavicle fractures 쇄골골절 Fracture of the Clavicle Conservative treatment Figure-of-eight bandage Surgical treatment Indications Skin tenting, significant cosmetic deformity Open fractures Neurovascular compromise Floating shoulder, multiple trauma Younger, active pt with shortening greater than 1.5 to 2cm 2

3 견봉쇄골관절손상 Acromioclavicular Joint Injury 견봉쇄골관절손상 Acromioclavicular Joint Injury AC joint stabilizer 견봉쇄골관절손상 Acromioclavicular Joint Injury AC joint injury mechanism Joint capsule Acromioclavicular ligament Coracoclavicular ligament 견봉쇄골관절손상 Acromioclavicular Joint Injury Rockwood classification Conservative Tx Ice bag Arm sling (or brace) Immobilization 1~6wk Surgical Tx 견봉쇄골관절 퇴행성관절염, 골용해증 (osteolysis) Weight lifting Bench press Heavy laborer Smashing player 통증과압통 수평내전시통증 Zanka view : 20º cephalic tilt view 3

4 견봉쇄골관절 퇴행성관절염, 골용해증 (osteolysis) Treatment 진통소염제 관절에국소주사제 원위쇄골절제성형술 연관통 Referred Pain 경추, 상부흉추 흔히어깨쪽으로통증을전달한다 연관통 Referred Pain 어깨의기능저하 견갑주위통증 or 승모근부위통증 Trigger point ( 통증유발점 ) Trapezius muscle ( 승모근 ) Infraspinatus muscle ( 극하근 ) Levator scapulae muscle ( 견갑거근 ) Rhomboideus muscle ( 마름모근 ) 그밖의원인 4

5 상완이두건 LHBT (Long Head of Biceps Tendon) From posterosuperior labrum & supraglenoid tubercle Site of origin: variable Labral origin : 50% Supraglenoid tubercle : 20% Both origins : 30% -Habermeyer, Unfallchirurg, 이두건병증 LHB tendinopathy Biceps tendinitis c/ rotator cuff ds. Mostly secondary to impingement sd LHB : ant. location of impingement zone Synovitis of LHB Within bicipital groove, under transverse humeral ligament Similar c/ dequervain s stenosing tenosynovitis -Neer, JBJS, Acute tendon ruptures 상완이두근파열 Sudden acute pain Both eccentric, concentric loads can lead to failure Most common type Pectoralis major rupture (at humeral insertion) Tear of long head of biceps Rotator cuff tear 구심성, 편심성수축을강하게사용하는운동선수 증상징후 Pop sound, 근육의불거짐, 근력약화 치료 Ice, 고정, 정형외과의즉각진료 노인 : 재건필요없는경우도있음 운동선수 : 수술필요 흉곽출구압박증후군 Thoracic outlet syndrome 목과어깨에있는상완신경총, 쇄골하동맥, 쇄골하정맥의압박 늑쇄골증후군 전사각근증후군 과외전증후군 : 소흉근에의해 경늑골증후군 감각이상, 냉감, 혈액순환장애, 근육위축 치료 : 스트레칭, 강화운동 수술 승모근, 능형근, 전거근, 척수기립근, 소흉근, 사각근 2000 Sydney Olympic Archery,Gold Medialist Bennett 병변 Posterior ossification of shoulder Calcification in triceps tendon insertion By traction injury Treatment Debridement of frayed labum & cuff -Ferrari, Reattachment of of post capsule & labrum Spectrum of peel-back lesion (Burkhart) -Warren- 5

6 견갑골체부및견봉골절 견갑골체부및견봉골절 견봉골절 스포츠에서드문손상 양쪽에있는근육으로잘보호됨 원인 직접적충격 상완골의힘이견갑골로이전될때 부종, 압통, 통증 어깨팔걸이 : 3주간 견갑골체부골절 상완골골절 근위상완골골절 상완골간부 기전 : 팔로직접떨어질때 복잡혹은횡단골절 요골신경마비 근위상완골 해부학적경부결절부, 외과적경부 골단골절 10세이하의어린이에서자주발생 기전 : 직접적인타박, 상완골을통한힘 가성마비 : 팔이짧아지고, 통증, 부종, 팔을안움직임 벨포붕대사용, 의사의지시 세개의주된골편의전위 (displacement) 골두 : c/ or s/ dislocation 간부 : pulled medially by pectoralis 결절 ( 대, 소 ): pull of attached Head rotator cuff shaft Attached tuberosity : Blood supply to head GT Sports injury??? 18 M, 태능선수촌유도 1. Rotator cuff tear 2. Biceps rupture 3. SLAP lesion 4. Internal impingement 5. Tuberosity fracture 16 M, 고교야구외야수 Sports injury Nonunion, lesser tubeoristy 18 M, 태능선수촌유도 16 M, 고교야구외야수 6

7 Sports injury Little league shoulder 14 M, 야구투수 견갑골이상운동증 SICK scapular syndrome -Warner 1992; Burkhart S - Scapular malposition I - Inferior border prominence C - Coracoid process pain K - scapular Dyskinesis Prodromal problems before SLAP lesion Dead arm syndrome Observational Assessment Observational Assessment Visual observation of scapular motion from behind the patient during Flexion & Scaption Type 1 Type 2 Type 3 tt Types - Kibler WB. Type 1 prominence of inferior medial scapular angle Type 2 prominence of entire medial border ( scapular winging) Type 3 prominence of superior scapular border superior migration of scapula Type 4 (=Normal) no prominence of inferior angle or medial/superior border Kibler WB. JSES & J Am Acad Orthop Surg Type 1 prominence of the Inferior medial scapular angle Type 2 prominence of the Entire medial border 7

8 Type 1 prominence of the Superior scapular border Type 4 Normal no prominence of inferior angle or medial/superior border SICK scapular syndrome Excessive scapula protraction with + Pectoralis minor tightness (hyperangulation) Lack of full retraction (protraction) : Increase anterior tilt subacromial space Weak trapezius, serratus ant, and rhomboids Int. impingement in athlete SLAP & Scapular dyskinesis Shoulder at risk : pre-slap prodrome Preventing SLAP is the most important and best treatment Treating the periscapular muscle is the key-point Treatment Treatment Relaxation - IMS 1. Relaxation a. Upper trapezius b. Levator scapula 2. Contraction a. Mid trapezius b. Lower trapezius c. Rhom major Contraction - Exercise 8

9 스포츠혹은일상생활로의복귀 Return to Sports 투구동작은피하고장시간운동하지않는다. 게임의강도는서서히올린다. 몇몇스포츠에서는 ( 예 :tennis 혹은 squash) 머리위로하는동작 (overhead motion) 을피한다. 그후 손상회복단계 지난 7월 12일오른쪽팔꿈치수술을받은오승환은회복속도가빨라 9월 30일대구구장에서열린청백전에서 4-1로앞선9회등판, 1이닝동안플레이오프선발라인업이확실한강봉규와채태인, 박한이등을공 9 개로깔끔하게요리했다. 제구뿐만아니라직구도최고 147km를찍어선감독을놀라게만들었다. OSEN= 이상학기자 ] 151km-150km-152km-151km. 전광판에거듭찍힌스피드에삼성관계자는감탄을금치못했다. ' 최강마무리 ' 오승환 (29) 의완벽한귀환을다시한번알리는상징과같은숫자였다. 오승환은올해 14경기에서블론세이브는물론승패없이세이브만 12개나쌓아올렸다. 세이브의질도다르다. 동점및역전주자가나간상황에서거둔터프세이브가 3개, 1점차상황에서거둔세이브가 7개나된다. 복귀 (Return to Participation) 운동재교육 (Motor Re-Learning) 지구력 (Endurance) 고유감각 (Proprioception) 운동범위 (ROM), 유연성 (Flexibility), 근력 (Strength) 스포츠현장에서의료진의역할 질병예방및치료 감기, 몸살, 설사, 감염, 풍토병 과사용손상예방을위한보호 재활치료, taping, brace 급성외상에대한적절한치료 손상시정신적 support 도핑 (Doping) control 정보제공및정신적휴식, 긴장완화 Take home messages Shoulder pain in Sports Various causes Accurate Diagnosis Proper management Conservative Tx Surgical Tx Rehabilitation Return to Sports 9

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