CASE STUDY

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1 Biomechanics GACHON UNVERSITY Dept, of Physical Therapy Choi Won Ho

2 Chapter3. Shoulder complex

3 학습목표 Q. 근육과관절의상호작용에대하여알아본다. 어깨근육들의작용 어깨가슴관절의근육들 팔을올림시키는근육들 어깨관절을모음시키고폄시키는근육들 어깨관절을안쪽돌림시키는근육들과가쪽돌림시키는근육들 3

4 Action of the shoulder muscles 몸쪽안정자 (proximal stabilizer) 척추, 갈비뼈, 그리고머리뼈에서시작하여어깨뼈와빗장뼈에부착하는근육들 Examples: 앞톱니근, 등세모근 먼쪽가동자 (distal mobilizers) 어깨뼈와빗장뼈에서시작하여위팔뼈와아래팔에부착하는근육들 Examples: 어깨세모근, 위팔두갈래근

5 Elevators of the scapulothoracic joint The muscles responsible for elevation of the scapula and clavicle are the upper trapezius, levator scapulae, and to a lesser extent, the rhomboids. 팔이음뼈의이상적인자세란? 어깨뼈가약간올림되고뒤당김되어있으며, 관절오목이약간위쪽으로향하고있는상태

6 6

7 Depressors of the scapulothoracic joint Depression of the scapulothoracic joint is performed by the lower trapezius, latissimus dorsi, pectoralis minor, and the subclavius.

8 Protractors of the scapulothoracic joint The serratus anterior muscle is the prime protractor at the scapulothoracic joint.

9 Retractors of the scapulothoracic joint The middle trapezius muscle has an optimal line-of-force to retract the scapula. The rhomboids and the lower trapezius muscle function as secondary retractors.

10 Muscles responsible for elevation of the arm 1. GH joint muscles Deltoid Supraspinatus Coracobrachlalis Biceps(long head) 2. Scapulothoracic joint muscles Serratus anterior Trapezius 3. Rotator cuff muscle

11 Muscles that elevate the arm at the glenohumeral joint The prime muscles that abduct the GH joint are the anterior deltoid, the middle deltoid, and the supraspinatus muscles.

12 Muscles that elevate the arm at the glenohumeral joint Elevation of the arm through flexion is performed primarily by the anterior deltoid, coracobrachialis, and long head of the biceps brachii.

13 Upward rotators at the scapulothoracic joint Upward rotation of the scapula is an essential component of elevation of the arm. To varying degrees, the serratus anterior and all parts of the trapezius cooperate during the upward rotation.

14 Trapezius and serratus anterior interaction 짝힘 (force couple) 위등세모근, 아래등세모근, 앞톱니근 팔의올림동안앞톱니근과등세모근은어깨뼈위쪽돌림의역학을조절한다. 앞톱니근은이러한동작에있어더큰지레작용을갖는다. 앞톱니근과등세모근은위쪽돌림에있어협력근으로사용 강력한내밈과뒤당김에각각사용되고서로에대해운동을제한하기때문에작용근과대항근이되기도한다.

15 Trapezius paralysis 등세모근의완전한마비는팔을머리위로올림시키는데있어현저한어려움을유발한다. 팔을머리위로들어올리는과제는앞톱니근의신경지배가유지되는한대개완전한범위로완성될수는있다. 중간등세모근은어깨뼈에대해강력한뒤당김의힘을발생시켜야하기때문에, 순수한이마면에서의팔의올림은등세모근의마비가있다면특히어렵다.

16 Serratus anterior paralysis 앞톱니근의마비는정상적인어깨운동학의붕괴를유발 앞톱니근의마비는긴가슴신경, 척수또는목신경뿌리의손상으로일어날수있다. Winging of the scapula

17 Function of the rotator cuff muscles during elevation of the arm 돌림근띠근육들 어깨밑근, 가시위근, 가시아래근, 작은원근 위팔뼈머리와관절오목사이의느슨한결합에의해 GH 관절은큰가동범위를갖는다. 관절주머니주변에는운동을제한할수있는굵은제한성인대들이없어야한다.

18 Function of the rotator cuff muscles 가시위근 위팔뼈머리의위쪽구르기를추진한다. 관절오목에대해위팔뼈머리를견고하게압박한다. 위팔뼈머리위에서반강체간격장치를만들어위팔뼈의과도한위쪽병진운동을제한한다. 가시아래근, 작은원근, 그리고어깨밑근 위팔뼈머리에대해내림의힘을발휘한다. 가시아래근과작은원근 위팔뼈를가쪽으로돌림시킨다. 18

19 Muscles that adduct and extend the shoulder *Latissimus dorsi muscle *Sternocostal head of the pectoralis major muscle *Teres major, long head of triceps, posterior deltoid *Infraspinatus, teres minor

20 Muscles that adduct and extend the shoulder 20

21 Internal rotator muscle of the shoulder *Subscapularis *Anterior deltoid *Pectoralis major *Latissimus dorsi *Teres major 어깨안쪽돌림근육의전체근육부피는가쪽돌림근육보다더크다. 편심과동심활성동안안쪽돌림근육들에의해생산된최대노력의토크가더크다는것을반영한다. 위팔뼈에대한어깨뼈의돌림운동에대한관절운동형상학은, 볼록한위팔뼈머리에대해오목한관절오목이같은방향으로구르기와미끄러지기를한다.

22 Internal rotator muscle of the shoulder 22

23 External rotator muscle of the shoulder *Infraspinatus *Teres minor *Posterior deltoid 가쪽돌림근육들은전체어깨의근육부피에있어비교적작은비율을차지하고있다. 가쪽돌림근육들은어깨에근육무리들중가장낮은최대노력의토크를생산해낸다. 빠르게길어지는가시아래근과작은원근에부과되는지점에서찢어짐이나만성염증을유발하여돌림근띠증후군을유발

Osteokinematics and Athrokinematics of the shoulder(정동춘).ppt

Osteokinematics and Athrokinematics of the shoulder 정동춘 ( 국민체력센터) Kinematics 공간에서의 운동(motion) 에 대한 과학 인간움직임에대한설명 주요 변인 a. 운동형태(translatory, rotatory, curvilinear) b. 운동위치(cardinal planes & diagonal planes)