Microsoft PowerPoint - 박진영

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Shoulder 스포츠손상과치료 박진영, PARK Jin-Young 건국대학교의학전문대학원 Shoulder, Elbow & Sports Service [OSEN= 대구, 손찬익기자 ] ' 난공불락 ' 오승환 (28, 삼성투수 )

선동렬 삼성 Pain 감독은 itself " 오승환은 is important 포스트시즌에진출하면그때가서다시생각해봐야겠다 " 고밝힌바있다.

50) 를기록했으며 지난달 To sports-loving 18 일 1 군엔트리에서 people: 말소된 important 바있다 t. issue to continue sports activity Athletes Injury?

Joint pain? 1 st thing to do 1. Baseball 2. Football (US) 3. Soccer 4. Swimming 5. Tennis 6. Golf 7. Ski 8.

Immobilization and then observation a. Nonathletes? : Accepted b. Athletes?

1 Shoulder 스포츠손상과치료 박진영, PARK Jin-Young 건국대학교의학전문대학원 Shoulder, Elbow & Sports Service [OSEN= 대구, 손찬익기자 ] ' 난공불락 ' 오승환 (28, 삼성투수 ) 이오른쪽팔꿈치뼈조각관절경수술을성공적으로마쳤다. 오승환은지난 8월 12일오른쪽팔꿈치에서웃자린뼈조각을제거하는수술을받았다. 구단관계자는 " 오승환이이틀간입원한뒤퇴원할 예정이며 Non-Athletes 향후재활일정을아직결정되지않았다 " 고밝혔다. 선동렬 삼성 Pain 감독은 itself " 오승환은 is important 포스트시즌에진출하면그때가서다시생각해봐야겠다 " 고밝힌바있다. 2006년부터 3년연속구원왕에 오른오승환은 Should 올시즌 not 16 disturb 경기에 daily 등판, 4 activity 세이브 ( 방어율 of living 4.50) 를기록했으며 지난달 To sports-loving 18 일 1 군엔트리에서 people: 말소된 important 바있다 t. issue to continue sports activity Athletes Injury? End of the season + loose everything Return to sports? as soon as possible Pain itself disturbs the sports activity Common injury in sports? Joint pain? 1 st thing to do 1. Baseball 2. Football (US) 3. Soccer 4. Swimming 5. Tennis 6. Golf 7. Ski 8. Snowboard Shoulder, Elbow Knee Knee Shoulder Elbow Shoulder & Knee Knee Wrist, Elbow If pathologic condition is not definite? 1. Immobilization and then observation a. Nonathletes? : Accepted b. Athletes? : Never accepted without complaint Rehabilitation is important in sports medicine. Warning signs in sports medicine Redness, heat, joint swelling, joint pain, stiffness, numbness, weakness and clicking sound Don t ignore them!! Prevent further damage! Immediately stop the activity R.I.C.E. (Rest, Ice, Compression, Elevation) Joint pain? 1 st thing to do If pathologic condition is not definite? 1. Observation 2. Icing 3. Immobilization 4. Pain medication 1

Principle in Sports Medicine Warm-up & Stretch your body before any kinds of sports activity Shoulder pain related with sports activity Pushing yourself too hard during sport or overdoing everyday

Snowboard Injury 상지의스노우보드손상 I Vail Colorado ski resorts, USA From 1988 to 1998 : 7430 cases 남자 : 여자 = 74% : 26% 초보자 : 39% 중급자 / 상급자 : 61% 상지손상 : 49% 골절 56% 염좌 27% 탈구 10% -Idzikowski 2000 Am J Sports

$Injury 상지의스노우보드손상 III 견관절부 (Shoulder) 945 cases 골절 (Fracture) 54 cases 탈구 (Dislocation) 227 cases 쇄골골절 (Clavicle fracture) 279 cases AC 관절탈구 385 cases 주관절부 (Elbow) 306 cases 골절 (Fracture) 79 cases 탈구$

2 Principle in Sports Medicine Warm-up & Stretch your body before any kinds of sports activity Shoulder pain related with sports activity Pushing yourself too hard during sport or overdoing everyday activities may be enough to trigger muscle or joint pain. Snowboard Injury 상지의스노우보드손상 I Vail Colorado ski resorts, USA From 1988 to 1998 : 7430 cases 남자 : 여자 = 74% : 26% 초보자 : 39% 중급자 / 상급자 : 61% 상지손상 : 49% 골절 56% 염좌 27% 탈구 10% -Idzikowski 2000 Am J Sports Med- Snowboard Injury 상지의스노우보드손상 II From 1988 to 1998 : 7430 cases Vail Colorado ski resorts 손상부위 수근관절부 (wrist) : 22% 초보자, 여자 어린사람들에서호발 수부 (hand), 주관절 (elbow), 견관절 (shoulder) 중급자, 상급자에서호발 Snowboard Injury 상지의스노우보드손상 III 견관절부 (Shoulder) 945 cases 골절 (Fracture) 54 cases 탈구 (Dislocation) 227 cases 쇄골골절 (Clavicle fracture) 279 cases AC 관절탈구 385 cases 주관절부 (Elbow) 306 cases 골절 (Fracture) 79 cases 탈구 (Dislocation) 227 cases 전완부골절 (Forearm Fx) 92 ases 수근관절부 (Wrist) 1570 cases 골절 (Fracture) 1199 cases 탈구 (Dislocation) 20 cases 염좌 (Sprain) 304 cases 주상골골절 (Scaphoid Fx) 47 cases 수부 (Hand) 161cases Snowboard Injury 견관절 (Shoulder) 전체상지손상중 32% (945/2982 cases) 손상기전 Backward fall : more often Forward fall : clavicle l Fx, AC D/L 손상종류 Fracture (including greater tuberosity Fx) & dislocation clavicle Fx, D/L AC joint rotator cuff tear 2

통증은몸의이상을알리는경계신호! Free Style Stroke 자유형과어깨통증 다치는장소는?

3 Snowboard Injury 견관절 (Shoulder) 각운동별견통의빈도 수영선수 66% 야구선수 ( 투수 ) 57% 배구선수 44% 창던지기선수 29% 수영 (Swimmer) 과견통 수영동작 ( 자유형 ) 어깨통증초기 : 진단이쉽다 진행되면 : 염증으로인한전체적인통증 참으면서수영계속시 : 어깨의손상 어깨손상의 50% 이상이재발 통증은몸의이상을알리는경계신호! Free Style Stroke 자유형과어깨통증 다치는장소는? 통증이가장심한동작 Pull-through 의초기 : 70% Recovery 의초기 : 18% 수영선수 233 명 (17 대학팀 ) 사체연구 회전근개, CA arch 로의이두박근건 전상방관절와순 인체견관절의특징 근육피로 (fatigue) 불안정성 (instability) 3

스트로크와근육피로 수영선수견관절의진단 전거근 (Serratus anterior) 견갑하근 (Subscapularis) 피로증가 피로증가 전방 & 중간삼각근 (ant & middle Deltoid), 승모근 (Trapezius), 능형근 (Rhomboid) 피로증가 Dropped elbow in Hand Exit 출구면충돌증후군 : NO!

4 스트로크와근육피로 수영선수견관절의진단 전거근 (Serratus anterior) 견갑하근 (Subscapularis) 피로증가 피로증가 전방 & 중간삼각근 (ant & middle Deltoid), 승모근 (Trapezius), 능형근 (Rhomboid) 피로증가 Dropped elbow in Hand Exit 출구면충돌증후군 : NO! 관절낭이완 : uncommon true instability! 관절낭이완에따른이차적인충돌현상 회전근개의스트레스증가 견갑골주위근육의기능약화 어깨손상의징후 (sign) 정상 / 비정상의조기발견 코치의역할가장중요 팔떨굼 (Dropped Elbow) 익상견 (Winging Scapula) 내회전 / 외회전 (Balance) 손상의미세징후 옆으로입수 (Wider entry) 견갑하근, 삼각근의수축감소 비대칭운동 (Asymmetric pull) 손상된팔에의한힘의불균형 레인중앙을벗어남 (Not staying in center) 반대쪽운동감소 - 발운동 ( 킥 ) 변화 빨리손빼기 (Early water exit) 과도한몸동작 (excessive body-roll) Throwing Mechanics 투구동작의역학 Wind-up : A,B,C,D Stride : D,E,F Arm cocking :FGH F,G,H Arm acceleration : H,I Arm deceleration : I,J Follow-through : J,K 4

극하근 견관절전방근육 : 강한작용 견갑하근 광배근 대흉근 투구동작시문제점

조직의재파괴 정상적인생역학의변화 이차적충돌증후군 라켓을이용하는선수손상기전

5 투구에중요한동작 투구동작의역학 Stride Arm cocking Arm acceleration 견관절후방근육 : 약한작용 극상근 삼각근중간부분 극하근 견관절전방근육 : 강한작용 견갑하근 광배근 대흉근 투구동작시문제점 I 투구동작시문제점 II 강력한구질의공 많은양의 arm acceleration + cocking Arm deceleration시엄청난가속도감소 Cocking과 arm deceleration 에서견관절손상이가능 과사용에따른편심성과부하 점차적인견관절손상 근육, 인대, 관절낭, 견와순 견관절불안정성 조직의재파괴 정상적인생역학의변화 이차적충돌증후군 라켓을이용하는선수손상기전 견봉쇄골관절 오랫동안라켓사용한선수 스매싱, 하이클리어 내적충돌증후군 어깨를너무뒤에서앞으로움직이며서틀콕을칠때 경도의전방불안정증 회전근개건염및파열 어깨위로라켓을많이사용할때 상방관절와순 (SLAP) 병변및결절낭종 : 넘어질때 Shoulder Sports Injury and Treatment 5

6 Pain anywhere in shoulder Mostly due to muscle weakness Important injuries are.. Glenohumeral instability SLAP and impingement Fracture Tendon rupture. 충돌 Impingement 충돌 Impingement 1. 외적충돌 (External impingement) 일차적외적충돌 Primary External Impingement between humeral head and acromion 일차적 (primary) 이차적 (secondary) 2. 내적충돌 (Internal impingement) 6

일차적외적충돌 Primary External Impingement 원인 Osteophyte( 골극 ) or Beak

Impingement 원인 Periscapular muslces : Imbalance Antero-Inferior

acromiale Superior translation of Humerus 내적충돌 Internal impingement

rotation 충돌부위관절와후 - 상방면 vs 회전근개하방면 내적충돌 Internal impingement Repeated

impingement repetitive hypertwisting of RC fiber fatigue & torsional

athletes with other pathology 충돌의치료 Treatment Rest, NSAIDs

7 일차적외적충돌 Primary External Impingement 원인 Osteophyte( 골극 ) or Beak 견봉하방면의모양 Curved type Hooked type 이차적외적충돌 Secondary External Impingement 원인 Periscapular muslces : Imbalance Antero-Inferior translation of Acromion Deltoid vs Rotator cuff : Imbalance Os acromiale Superior translation of Humerus 내적충돌 Internal impingement 구기운동선수 mostly in Late cocking Extension Abduction (>90º) External rotation 충돌부위관절와후 - 상방면 vs 회전근개하방면 내적충돌 Internal impingement Repeated hyperexternal rotation at cocking cause pathologic internal impingement repetitive hypertwisting of RC fiber fatigue & torsional overload failure of RC cause of dead arm syndrome in throwing athletes with other pathology 충돌의치료 Treatment Rest, NSAIDs Subacromial injection Strengthening exercise Periscapular muscle Rotator cuff ASD : arthroscopic subacromial decompression 7

회전근개손상 Rotator Cuff Injury 회전근개건병증 Rotator cuff tendinopathy 회전근개손상 Rotator Cuff Injury 회전근개염좌

회전근개건병증 Rotator Cuff Tendinopathy Overuse Apoptosis Tendinosis 단백질키나아제활성화콜라겐합성저하, 기질재형성저하시간의경과

Painful arc : 70~120º Tendon rupture Impingement sign & test + MRI : useful 회전근개건병증 Rotator

Tear Complete tear Repair Mini-open repair 통증호전 + 기능향상 Treatment of Comorbidity Glenohumeral

8 회전근개손상 Rotator Cuff Injury 회전근개건병증 Rotator cuff tendinopathy 회전근개손상 Rotator Cuff Injury 회전근개염좌 / 파열 Rotator cuff strain/tear 석회화건염 Calcific tendinitis 회전근개건병증 Rotator Cuff Tendinopathy 회전근개건병증 Rotator Cuff Tendinopathy Overuse Apoptosis Tendinosis 단백질키나아제활성화콜라겐합성저하, 기질재형성저하시간의경과 Clinical manifestation & Diagnosis Pain in overhead activity Tenderness on Greater tuberosity Painful arc : 70~120º Tendon rupture Impingement sign & test + MRI : useful 회전근개건병증 Rotator Cuff Tendinopathy Treatment Rest, Ice bag Subacromial steroid injection 회전근개파열 Rotator Cuff Tear Complete tear Repair Mini-open repair 통증호전 + 기능향상 Treatment of Comorbidity Glenohumeral instability Muscle weakness Capsular tightness Scapular dyskinesis Arthroscopic repair 1열봉합술 2열봉합술 골터널봉합술 교량형봉합술 8

관절와순손상 Glenoid Labrum Injury 관절와순손상 Glenoid Labrum Injury SLAP 병변 ( 상부관절와순전후병변 ) Superior Labrum

mechanism HyperER +Abduction 상부관절와순전후병변 SLAP lesion Andrews: 1 st described in athletes Snyder:

9 관절와순손상 Glenoid Labrum Injury 관절와순손상 Glenoid Labrum Injury SLAP 병변 ( 상부관절와순전후병변 ) Superior Labrum from Anterior to Posterior lesion 상부관절와순전후병변 SLAP lesion Injury mechanism Throwing overuse Rupture of the biceps! Bankart 병변 ( 전방관절와순파열 ) shoulder instability Other labral injuries 상부관절와순전후병변 SLAP lesion Injury mechanism HyperER +Abduction 상부관절와순전후병변 SLAP lesion Andrews: 1 st described in athletes Snyder: characterized & classified Repeat overhead-throwing : Peel-back P l b k mechanism Scapular protraction GIRD (glenohumeral internal rotation deficiency) Exessive inferior traction ( 무거운물건들어옮기기 ) 9

상부관절와순전후병변 SLAP lesion SLAP repair 상부관절와순전후병변

Service 관절와순주위낭종 Paralabral Cyst Communication

Weakened rotator cuff posterior-superior shoulder

catching, popping Nerve compression weakness,

compensatory hypertrophy of teres minor 관절와순주위낭종

MRI Conservative Tx 휴식, 활동변형, 소염진통제 후방관절낭

Spinoglenoid notch cyst Arthroscopic labrum

10 상부관절와순전후병변 SLAP lesion SLAP repair 상부관절와순전후병변 SLAP lesion Type III Konkuk Univeristy Hospital Shoulder, Elbow & Sports Service Konkuk Univeristy Hospital Shoulder, Elbow & Sports Service 관절와순주위낭종 Paralabral Cyst Communication with G-H joint No evidence for proposed origin Sx Weakened rotator cuff posterior-superior shoulder pain Similar with labral injury locking, catching, popping Nerve compression weakness, burning sensation Difficult to detect d/t compensatory hypertrophy of teres minor 관절와순주위낭종 Paralabral Cyst Diagnosis 임상증상, 진찰 근전도, 신경전도검사 MRI Conservative Tx 휴식, 활동변형, 소염진통제 후방관절낭 stretching 근력강화재활 : 견관절안정화근육강화 관절와순주위낭종 Paralabral Cyst Surgical Tx. Depend on cyst location & on associated Sx. Spinoglenoid notch cyst Arthroscopic labrum repair Suprascapular notch cyst Arthroscopic glenohumeral joint evacuation Labral repair ± open decompression of nerve & cyst excision 10

관절와상완관절탈구 Dislocation of Glenohumeral Joint 관절와상완관절탈구 Dislocation of

the activity Extreme pain on the first event 관절와상완관절탈구 Dislocation

dislocations Holds the extremity in abduction & ER position

3%) Extremity is internally rotated and adducted 전방탈구 Anterior

+ Hyper-ER 에의해발생 전방관절와순의손상 Bankart lesion 전방관절와골절 bony Bankart

전방탈구 Anterior Dislocation X-ray finding 원칙적으로정복전에시행 Reduction 전방탈구

11 관절와상완관절탈구 Dislocation of Glenohumeral Joint 관절와상완관절탈구 Dislocation of Glenohumeral Joint Acute Glenohumeral Dislocations Cannot continue the activity Extreme pain on the first event 관절와상완관절탈구 Dislocation of Glenohumeral Joint Anterior Dislocation 90% of the acute dislocations Holds the extremity in abduction & ER position Posterior Dislocation Rare (1~4.3%) Extremity is internally rotated and adducted 전방탈구 Anterior Dislocation Injury mechanism Hyper-Abd. + Hyper-ER 에의해발생 전방관절와순의손상 Bankart lesion 전방관절와골절 bony Bankart lesion 상완골두의후방압박골절 Hill-Sachs lesion Axillary nerve injury( 외측감각이상 ) 전방탈구 Anterior Dislocation X-ray finding 원칙적으로정복전에시행 Reduction 전방탈구 Anterior Dislocation Recurrence after the 1st event < 22 years old High recurrence! Recurrence in 60~70% May consider primary surgery in athletes Still mostly accepted treatment for the 1 st D/L : Immobilization for 3~4 weeks 골절발생가능 These are not absolute treatment methods Need immobilization or surgery 11

전방탈구 Anterior Dislocation Arthroscopic treatment 최초탈구자는비수술적요법이추천되지만, 최근 20대이전의급성전방탈구에서는

전방탈구 Anterior Dislocation Open treatment Severe glenoid bone loss Latarjet procedure GLAD 병변 Glenoid

10.21- 시즌막판이미수술을결정한상태였던박석민은 10월 25일건국대병원에서팔꿈치뼛조각을제거하는수술을먼저받는다.

좌타자인장성호는타석에서헛스윙할때어깨통증이심했지만이를참고시즌을마쳤다. 사흘전건국대병원에서오른쪽어깨연골봉합수술을받았다. 복귀후 15경기연속출루행진을이어갈정도로꾸준하다.

12 전방탈구 Anterior Dislocation Arthroscopic treatment 최초탈구자는비수술적요법이추천되지만, 최근 20대이전의급성전방탈구에서는 처음치료로수술적치료도추천되고있다. 전방탈구 Anterior Dislocation Open treatment Severe glenoid bone loss Latarjet procedure 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) 12

13 어깨강직 ( 동결견 ) Shoulder Stiffness( Frozen Shoulder ) 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 13

$팔을밖으로펴서떨어질때 어깨로떨어질때 직접적인충격 Mid 1/3 fracture In$ $adult : more than two-thirds of clavicle fractures$ Fracture of the Clavicle Conservative treatment

Fracture of the Clavicle Conservative treatment

$deformity Open fractures Neurovascular compromise$ Floating shoulder, multiple trauma Younger, active

5 to 2cm 견봉쇄골관절손상 Acromioclavicular Joint Injury

stabilizer injury mechanism Joint capsule

14 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 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 14

견봉쇄골관절손상 Acromioclavicular Joint Injury Rockwood

brace) Immobilization 1~6wk Surgical Tx 견봉쇄골관절 퇴행성관절염,

laborer Smashing player 통증과압통 수평내전시통증 Zanka view : 20º

Treatment 진통소염제 관절에국소주사제 원위쇄골절제성형술 연관통 Referred Pain 경추,

승모근부위통증 Trigger point ( 통증유발점 ) Trapezius muscle ( 승모근 )

15 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 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 ) 15

그밖의원인 상완이두건 LHBT (Long Head of Biceps Tendon) From

-Habermeyer, Unfallchirurg, 1987- 이두건병증 LHB

Mostly secondary to impingement sd LHB : ant.

Within bicipital groove, under transverse humeral

tenosynovitis -Neer, JBJS, 1972- Acute tendon

concentric loads can lead to failure Most common

insertion) Tear of long head of biceps Rotator cuff

16 그밖의원인 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 16

흉곽출구압박증후군 Thoracic outlet syndrome 목과어깨에있는상완신경총, 쇄골하동맥, 쇄골하정맥의압박

스트레칭, 강화운동 수술 승모근, 능형근, 전거근, 척수기립근, 소흉근, 사각근 2000 Sydney Olympic

shoulder Calcification in triceps tendon insertion By traction

1994- Reattachment of of post capsule & labrum Spectrum of

스포츠에서드문손상 양쪽에있는근육으로잘보호됨 원인 직접적충격 상완골의힘이견갑골로이전될때 부종, 압통, 통증 어깨팔걸이 :

근위상완골 해부학적경부결절부, 외과적경부 골단골절 10세이하의어린이에서자주발생 기전 : 직접적인타박, 상완골을통한힘

(displacement) 골두 : c/ or s/ dislocation 간부 : pulled medially by

17 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- 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 17

Sports injury??? 18 M, 태능선수촌유도 1. Rotator cuff tear 2.

$Tuberosity fracture 16 M, 고교야구외야수 Sports injury$ Nonunion, lesser tubeoristy 18 M, 태능선수촌유도 16 M,

야구투수 견갑골이상운동증 SICK scapular syndrome -Warner 1992;

border prominence C - Coracoid process pain K -

lesion Dead arm syndrome Observational Assessment

scapular motion from behind the patient during Flexion

Type 1 prominence of inferior medial scapular angle

winging) Type 3 prominence of superior scapular border

18 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 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 Type 2 prominence of the Inferior medial scapular angle

of the Superior scapular border Normal no prominence of inferior

Scapular dyskinesis Excessive scapula protraction with +

retraction (protraction) : Increase anterior tilt subacromial

risk : pre-slap prodrome Preventing SLAP is the most important p

19 Type 1 Type 2 prominence of the Inferior medial scapular angle prominence of the Entire medial border Type 1 Type 4 prominence of the Superior scapular border Normal no prominence of inferior angle or medial/superior border SICK scapular syndrome SLAP & Scapular dyskinesis Excessive scapula protraction with + Pectoralis minor tightness (hyperangulation) Lack of full retraction (protraction) : Increase anterior tilt subacromial space Weak trapezius, serratus ant, and rhomboids Shoulder at risk : pre-slap prodrome Preventing SLAP is the most important p and best treatment Treating the periscapular muscle is the key-point Int. impingement in athlete 19

Treatment Treatment Relaxation - IMS 1. Relaxation a. Upper trapezius b. Levator scapula 2.

Rhom major Contraction - Exercise 스포츠혹은일상생활로의복귀 Return to Sports 투구동작은피하고장시간운동하지않는다. 게임의강도는서서히올린다.

그후 손상회복단계 지난 7월 12일오른쪽팔꿈치수술을받은오승환은회복속도가빨라 9월 30일대구구장에서열린청백전에서 4-1로앞선9회등판, 1이닝동안플레이오프선발라인업이확실한강봉규와채태인,

전광판에거듭찍힌스피드에삼성관계자는감탄을금치못했다. ' 최강마무리 ' 오승환 (29) 의완벽한귀환을다시한번알리는상징과같은숫자였다.

20 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 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) 20

21 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 경청하여주셔서감사합니다. 21

Microsoft PowerPoint - 박진영

Microsoft PowerPoint - 박진영 Shoulder 스포츠 손상과 치료 강의를 초청하여 주셔서 감사합니다 감사합니다.. 박진영, PARK Jin-Young 건국대학교 의학전문대학원 Shoulder, Elbow & Sports Service Sports injury?? Sports injury?? Sports injury?? AC joint injury Most common injury in contact