Original Article doi:http://dx.doi.org/10.5397/cise.2012.15.2.79 대한견 주관절학회지제15권제2호 Clinics in Shoulder and Elbow Volume 15, Number 2, December, 2012 등속성검사를통한견관절전방불안정환자와정상인의회전력비교 고려대학교의과대학정형외과학교실, 고려대학교안암병원스포츠의학센터 이동기 김태권 이진혁 이대희 정웅교 Comparison of Rotational Strength in Shoulders with Anterior Instability and Normal Shoulders Using Isokinetic Testing Dong-Ki Lee, M.D., Tae-Kwon Kim, M.D., Jin-Hyuck Lee, M.D., Dae-Hee Lee, M.D., Woong-Kyo Jung, M.D. Department of Orthopedic Surgery, Sports Medicine Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea Objective: It has been expected that patient with posttraumatic recurrent anterior shoulder dislocation might have limited daily life activity because of pain and apprehension of dislocation. But there have been only a small number of investigations regarding the rotator strength in this patient. The aim of this study is to find the characteristics about rotator strength of patient with posttraumatic recurrent anterior shoulder dislocation using an isokinetic testing. Method: We enrolled thirteen patients with posttraumatic recurrent anterior shoulder dislocation and fifteen sex, age-matched healthy nonathletic subjects in this controlled study. All participants were male and there were no significant differences between the two groups in age, height, weight, BMI. Isokinetic internal rotator and external rotator strength was evaluated with a Biodex Isokinetic Testing machine (Biodex Medical Systems, Shirley, NY, USA), tests were performed at 60 deg/sec and 180 deg/sec for both sides. Peak torque normalized to body weight, external rotator to internal rotator ratio, total work and fatigue were calculated for each angular velocity. The association between internal rotator and external rotator strength and shoulder instability was analyzed by comparisons with a control group. Results: Any notable differences could not be found between the two groups given all data from no symptomatic left shoulder. There were no significant differences between the two groups statistically in internal rotation strength of right shoulder. However, there has been a tendency that at all angular velocities, external rotator peak torque to body weight, total work and external rotator to internal rotator ratio were significantly lower in the anterior instability group than the control group at all angular velocities. There was no substantial difference between those groups with respect to the fatigue of external rotator and internal rotator in our study. Conclusion: The prominent characteristics of posttraumatic recurrent anterior shoulder dislocation are external rotator weakness and loss of balance with external rotator and internal rotator. Therefore selective training using this information rotator might be helpful in conservative treatment and rehabilitation. Key Words: Shoulder, Anterior instability, Isokinetic muscle strengthening test 통신저자 : 정웅교서울특별시성북구안암동 5가 126-1 고려대학교안암병원정형외과 Tel: 02) 920-6779, Fax: 02) 924-2471, E-mail: drshoulder@korea.ac.kr 접수일 : 2012 년 4 월 18 일, 1 차심사완료일 : 2012 년 6 월 21 일, 2 차심사완료일 : 2012 년 10 월 23 일, 게재확정일 : 2012 년 11 월 14 일 79
대한견 주관절학회지제 15 권제 2 호 서론견관절, 특히관절와상완관절은상완골두와견갑골의관절와가만나서이루는관절로여러가지해부학적특징으로인하여우리몸에서가장넓은운동범위로움직일수있는반면매우불안정한구조를가지고있다. 1) 견관절은가장흔하게탈구되는관절중하나로견관절불안정성은상완골두와관절와사이에서골, 연부조직, 그리고근육이상완골두의전위를제한하지못하는경우에발생할수있고, 2) 또한어깨주위의근력의감소및동적안정구조의불균형은재발성견관절전방불안정을흔히초래할수있다고알려져있다. 3,4) Kirkley 등 5) 은이러한외상성견관절불안정성을보이는다수의환자에서지속적인견관절재탈구에대한불안감, 무력감혹은동통으로인하여스포츠를포함한일상생활활동이제한을받고그능력이감소한다고보고하였다. 이에견관절불안정성환자에있어서어깨근력의특성에관한연구가이루어져왔지만다양한결과가보고되고있으며, 이는이전에시행된연구가연구목적, 근력측정방법이다르고, 연구대상도다양한종류와경력의운동선수부터일반인까지포함되어있으며, 불안정성의종류역시일치되지않는등여러교락인자가교정되지않았기때문이다. 어깨근력을측정및분석하는방법으로등장성, 등척성, 등속성운동방법등이있으며이중등속성운동은결과를객관적으로측정할수있고관절운동에서근육이수축하는힘이가장약한부위를넘어설수있으며, 근육자체의길이장력 (length-tension) 기능을이용할수있고, 연축 (spasticity) 도어느정도극복할수있는장점을가지고있다. 6) 국내에서도김등 7) 이회전근개파열환자의수술전, 후의등속성어깨 근력에대하여보고하였고, 김등 8) 은 1, 2 단계충돌증후군환자에서등속성근력을측정하였다. 그러나견관절전방불안정환자만을대상으로등속성검사를통한견관절근력평가는드문실정이다. 이에저자들은외상성견관절전방불안정환자와정상인사이의내회전및외회전력에대한등속성근력검사를통하여전방불안정환자에서나타나는회전력의변화를살펴보고자하였다. 연구대상및방법연구대상신체검사와자기공명영상촬영상우측우세수의견관절전방불안정진단하에수술적치료를시행한환자중수술전등속성근력검사를시행한 13 명을대상으로하였다 (Table 1). 대조군은환자군과비교하기위해연령과성별을고려한견관절의전방불안정증상이없는정상성인 15 명을모집하였다. 환자군의평균나이는 25.4세 ( 표준편차 = 7.6, 범위 : 19~41세 ) 였으며대조군의평균나이는 24.1세 ( 표준편차 = 3.0, 범위 19~31세 ) 였다. 또한환자군의평균신장은 176.9 cm ( 표준편차 = 4.8, 범위 : 170.0~185.5 cm) 였으며대조군의평균신장은 176.5 cm ( 표준편차 = 4.8, 범위 : 167.0~183.0 cm) 였고환자군의평균체중은 78.9 kg ( 표준편차 = 17.0, 범위 : 62~126.0 kg) 였으며대조군의평균체중은 72.6 kg ( 표준편차 = 13.4, 범위 : 55~110.0 kg) 였다. 환자군의평균체질량 (BMI, body mass index) 는 25.1 ( 표준편차 = 4.7, 범위 : 20.5~36.6) 였으며대조군의평균평균체질량은 23.3 ( 표준편차 =3.9, 범위 : 17.6~33.6) 였으나통계학적으 Table 1. Patients demographic data Case Age Sex Duration (Month) Number of dislocation Lesion of labral tear Combined abnormality Sulcus grade 1 21 M 6 3 1~6 No 2 2 21 M 4 3 2~5 No 2 3 29 M 108 10 12~6 SLAP 2 4 38 M 72 20 2~6 No 1 5 20 M 36 30 2~6 No 2 6 23 M 36 8 1~6 No 2 7 19 M 36 15 11~6 SLAP 1 8 19 M 24 6 2~6 No 2 9 22 M 24 20 2~6 No 1 10 21 M 6 10 3~7 No 2 11 41 M 24 5 2~6 No 2 12 34 M 9 20 2~6 No 1 13 22 M 24 3 2~6 No 2 80
이동기 : 등속성검사를통한견관절전방불안정환자와정상인의회전력비교 로두군에서나이와신장, 체중, 체질량분포에서차이를보이지않았다. 성별은모두남성이었으며전예에서우측우세수에견관절전방불안정증이이환되었다. 연구방법등속성근력검사는 Biodex multi-joint system 4 (Biodex Medical Systems, Shirley, NY, USA) 을사용하였고, 60 deg/sec, 180 deg/sec 의각속도로견관절의외회전과내회전의체중을보정한최대우력 (peak torque) 과총일량을측정하였고, 외회전 / 내회전의비율및운동피로도를계산하였다. 등속성근력검사전검사의목적과기구의작동원리를피검자에게충분히설명하여최대능력이발휘되도록하였고, 미리예비검사를실시하여측정치오차를최소화하였다. 검사자는검사대위에앉은자세에서상체와하체를곧게하고상완과기계의회전축이일치되도록조절하여검사를하였으며, 견관절은 80 외전, 주관절은 90 굴곡된상태를유지하며전완은중립상태에서검사하였다 (Fig. 1). 양측견관절을측정하였으며환측의견관절과비교할자료를구축하기위해, 또한대상자의등속성근력측정기계에대한적응을연습하기위해, 그리고대상자의두려움을줄이기위해건측어깨부터검사를시행하였고, 환자에게먼저외회전, 내회전관절운동을하여불안정을느끼지않는범위내에서측정을하였다. 등속성운동근력평가는 60 deg/sec, 180 deg/sec의각속도에대해동적근력검사를최대의힘으로각각 5회, 15회반복시행하여각각의평균값을기록하였으며두군간에외회전및내회전의최대우력과총일량, 외회전 / 내회전비율, 운동피로도를비교하여전방불안정환자의회전력의특징을분석하고자하였다. Chicago, IL, USA) 를이용하여시행하였으며 Mann-Whitney 통계분석를이용하여환자와대조군간나이, 신장, 체중, 신체질량지수 (BMI) 를비교하였다. 두군의 60 deg/sec, 180 deg/sec 의각속도에서의견관절의외회전과내회전의체중을보정한최대우력과총일량및, 외회전 / 내회전의비율과운동피로도를비교하기위해서 Mann-Whitney 통계분석을이용하였으며 p<0.05 시에통계학적으로의미있다고판단하였다. 결과좌측견관절의외회전력및내회전력의체중보정최대우력과총일량은양군사이에차이가없었다 (p>0.05). 또한좌측견관절의외회전 / 내회전최대우력비율과피로도역시통계적인차이가없었다 (p>0.05). 우측견관절에서는불안정증이있는군에서대조군에비하여외회전력의체중보정최대우력및외회전 / 내회전최대우력비율 (Fig. 2), 총일량이모두의미있게감소되었다 (p<0.05) (Table 2, 3). 하지만내회전력의체중보정최대우력및총일량은양군사이에차이가없었다 (p>0.05). 운동피로도는외회전력, 내회전력모두양군간에의미있는차이는없었다 (Table 4). 모든측정결과는 60 deg/sec와 180 deg/sec의두각속도에서동일한결과가분석되었다. 고찰견관절은어느관절보다탈구가빈번히발생하는관절이고그중에서도전방탈구가대부분을차지한다. 견관절의전방탈구는접촉성운동에참여하는젊은선 통계학적분석 통계학적분석은 SPSS 12.0 software (SPSS Inc, Fig. 1. Subject positioned for shoulder rotation with shoulder abducted 80, elbow flexed 90, forearm neutralized. Fig. 2. The graph shows external rotator peak torque to body weight and external rotator to internal rotator ratios were lower in the anterior instability group than the control group at every angular velocities (IR = internal rotators, ER = external rotators, PTBW = peak torque relationship to body weight, PT ratio = peak torque ratio external rotator to internal rotator ratio). 81
대한견 주관절학회지제 15 권제 2 호 Table 2. Internal rotator and external rotator peak torque to body weight and external rotator to internal rotator ratios Dominant* Nondominant* Control Group Instability Group P-value Control Group Instability Group P-value 60 deg/sec External rotators 39.1±7.8 29.8±5.0 0.001 34.8±7.5 30.8±7.6 0.102 Internal rotators 59.0±8.6 54.4±13.5 0.167 54.0±10.2 51.0±12.3 0.596 ER/IR ratio 66.6±10.8 52.8±7.8 0.001 65.1±12 59.1±10.9 0.174 180 deg/sec External rotators 36.0±7.3 29.8±10.4 0.040 32.4±6.7 32.5±11.4 0.945 Internal rotators 55.3±8.1 52.9±11.0 0.222 52.0±6.7 52.9±14.4 0.908 ER/IR ratio 65.3±10.6 53.6±11.3 0.006 62.3±8.7 57.9±11.8 0.322 *The values are given as the mean and the standard deviation. IR = internal rotators, ER = external rotators. Table 3. Internal rotator and external rotator total work Dominant* Nondominant* Control Group Instability Group p-value Control Group Instability Group p-value 60 deg./sec External rotators 168.5±59.7 120.0±36.6 0.023 151.7±56.5 134.5±41.2 0.565 Internal rotators 269.3±67.2 252.5±73.1 0.836 257.4±71.0 255.9±71.7 0.025 180 deg/sec External rotators 329.7±115.2 193.8±76.9 0.002 308.2±126.0 253.1±133.9 0.222 Internal rotators 672.7±169.4 521.2±237.5 0.084 670.3±166.5 591.8±221.8 0.174 *The values are given as the mean and the standard deviation. IR = internal rotators, ER = external rotators, TW = total work. Table 4. Internal rotator and external rotator fatigue Dominant* Nondominant* Control Group Instability Group p-value Control Group Instability Group p-value External rotators 30.7±12.9 31.8±16.0 0.945 28.4±16.2 23.4±20.0 0.695 Internal rotators 20.1±7.2 20.1±9.6 0.872 17.7±9.9 9.0±20.3 0.447 *The values are given as the mean and the standard deviation. 수에서흔히발생하는손상으로서증세를동반한불안정성으로진행되어나타날수있다. 탈구가반복됨에따라관절낭의이완이나근력의불균형이초래되기도하고반대로균형이소실된근력으로인해불안정증이더욱악화될수있어어깨불안정환자의근력변화를이해하는것이중요하다. 근력을측정하기위하여다양한방법이사용되고있지만 1967 년 Hislop 등 9) 에의하여등속성운동의개념이도입된이래관절수술, 골절, 근육이나건및인대손상후물리치료나치료효과에대한평가에유용하게이용되고있다. 견관절불안정성환자에있어서도어깨근력의등속성운동에관한다수의연구가진행되었으나측정대상과여러불안정증이혼재되어분석되었고, 측정에사용된기계, 각속도및자세역시일치되지않아다양 한결과가보고되고있다. 10-15) 이에본연구에서는평가에혼란을줄수있는교락인자들을제거하기위해외상성전방불안정성을보이는일반인을대상으로등속성근력측정을시행하였고전방관절낭과회전근개에가해지는부하를최소화한상태에서견관절탈구의위험을줄이기위하여앉은자세에서검사를진행하였다. 10,16-19) 대조군과환자군사이의체중과 BMI 의차이를최소화할수있도록대조군을선정하였고체중은체내근육량과비례하고이는근력에밀접한영향을미치기때문에체중에의한근력의차이를보정하고최대우력 (peak torque) 을좀더정확히비교하기위해체중을보정한최대우력을비교하였다. 20-22) 본연구에서는외회전력의체중보정최대우력과총일량은 60 deg/sec 및 180 deg/sec 두각속도에 82
이동기 : 등속성검사를통한견관절전방불안정환자와정상인의회전력비교 서모두정상인에비하여전방불안정환자에서감소되었고, 내회전력은차이를보이지않았다. 또한, 외회전 / 내회전의최대우력비율역시감소된결과를보이고있어이전에시행된연구와다소차이를나타내고있다. Bak 과 Magnussen 등 14) 은견관절의오구돌기하충돌및통증을나타내는엘리트수영선수의등속성어깨근력평가에서내회전력이감소되어있음을보고하였다. 본연구결과와의차이는측정대상이어깨의내회전력이일반인에비해많이증가되어있는수영선수인점에서기인한다고생각할수있다. 오구돌기하충돌에의한통증으로인해외회전력보다내회전력이더욱영향을받아약화되었을것으로사료된다. Warner 등 10) 의연구에서도불안정한견관절에서내회전력의감소를보고하였다. 이연구에서도대상군에투구동작을하는운동선수가다수포함되어있어일반인을대상으로한저자들의연구와상반된결과가도출되었을것으로생각된다. Tsai 등 12) 은수술전습관성견관절전방불안정성환자에서외전력및내회전력이감소되어있다고보고하였다. 이연구에서는근력의감소를건측과환측의등속성근력의차이로계산하였고불안정한견관절이우세수, 비우세수에혼재되어있다. 저자들은 Ivey 등 23) 의연구결과를토대로우세수와비우세수사이에견관절의근력이유의한차이가없어저자들의결과에편향이발생하지않았을것이라고하였으나, Warner 등 10) 의연구를포함한이전의다른연구에서는반대로우세수와비우세수의견관절근력간의유의한차이를보고하고있어대조군과근력을비교하고이환된견관절의우세수여부를일치시긴본연구와는차이가있을것으로생각된다. 최근 Edouard 등 24) 은전방불안정성을환자에서내회전력및외회전력이모두감소되었음을보고하였다. 내회전력의감소는저자들은견관절을 80 외전한자세로근력을측정하였으나이연구에서는견관절을 45 외전한상태로검사를시행하여중력에의한영향을저자들보다작았기때문이었을것으로생각된다. 하지만이를확인하기위해견관절외전각도에따른내회전력및외회전력사이의변화에관하여추가적인연구가필요할것으로사료된다. 저자들의결과에서외회전력이감소한이유는다음과같이생각할수있다. 첫째, 본연구의측정자세중견관절의외전이다른연구에비해상대적으로크기때문에중력의영향을더받았기때문이다. 둘째, 전방불안정환자들이일상생활, 스포츠활동중에서의도적으로외전, 외회전자세를피하였을가능성이높고이에따라근력의감소가유발되었기때문이다. 마지막으로본연구의측정자세가환자에게불안감을유발할수있는자세라는점이다. 하지만, 근력측정전환자에게먼저관절운동을실시하여탈구에대한불안감을느끼 기전까지운동각도를제한하여자세로인한영향을최소화하였으므로이로인한감소는고려하지않아도될것으로생각된다. 본연구의한계로연구대상이많지않으며, 실험군및대조군이모두남성만을대상으로진행되었다는점, 그리고모든환자가우측우세수환자였다는점이다. 하지만, 본연구는연구대상을외상성전방불안정환자에한정하였고성별과이환된견관절의우세수여부를대조군과일치시켜측정의결과에왜곡이적은장점이있다고생각된다. 또한본연구는국내에서외상성견관절전방불안정성환자의회전력을등속성근력평가법을사용하여평가하고처음보고하는것으로이는향후견관절탈구환자의보존적치료나재활프로그램에기초자료를제시할수있다는점에서가치가있다고판단된다. 결 견관절전방불안정환자는정상인과비교하여외회전력이감소되고이로인한외회전 / 내회전력의균형이변화되는특징을보였다. 따라서외상성전방불안정성환자에서보존적치료및재활시에외회전력운동을강조하는것이어깨근력의균형을회복시켜불안정성을호전시킬수있을것이다. 하지만보다많은환자의측정과다양한외전자세에서의근력측정이추가적으로필요할것으로생각된다. 론 REFERENCES 1) Ko SH, Kim SJ, Kim SH, et al. The Shoulder and Elbow. 1st ed. Seoul: Korean Shoulder and Elbow Society; 2007. 29-35. 2) Dodson CC, Cordasco FA. Anterior glenohumeral joint dislocations. Orthop Clin North Am. 2008;39: 507-18. 3) Levine WN, Flatow EL. The pathophysiology of shoulder instability. Am J Sports Med. 2000;28:910-7. 4) Myers JB, Lephart SM. The role of the sensorimotor system in the athletic shoulder. J Athl Train. 2000;35: 351-63. 5) Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy. 1999;15:507-14. 6) Ha KI HS, Chung MY, Ryu JW. Efficiency of Isokinetic Exercise After Menicectomy. J Korean Sports Med. 1986;4:5-9. 7) Kim JY, Kim JY, Tae SK, et al. Pre- and Postopera- 83
대한견 주관절학회지제 15 권제 2 호 tive Isokinetic Strength Test in Rotator Cuff Tear. Clin Should Elbow. 2011;14:179-86. 8) Kim DW, Kim DW, Joo HK, Joo HK, Jung JE, Jung JE. Comparison of Isokinetic Strength between Stage 1,2 Impingement Syndrome and Rotator Cuff Tear. J Korean Shoulder Elbow Soc. 2010;13:53-7. 9) Thistle HG, Hislop HJ, Moffroid M, Lowman EW. Isokinetic contraction: a new concept of resistive exercise. Arch Phys Med Rehabil. 1967;48:279-82. 10) Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med. 1990;18:366-75. 11) Codine P, Bernard PL, Pocholle M, Herisson C. Isokinetic strength measurement and training of the shoulder: methodology and results. Ann Readapt Med Phys. 2005;48:80-92. 12) Tsai L, Wredmark T, Johansson C, Gibo K, Engström B, Törnqvist H. Shoulder function in patients with unoperated anterior shoulder instability. Am J Sports Med. 1991;19:469-73. 13) Rupp S, Berninger K, Hopf T. Shoulder problems in high level swimmers--impingement, anterior instability, muscular imbalance?. Int J Sports Med. 1995;16:557-62. 14) Bak K, Magnusson SP. Shoulder strength and range of motion in symptomatic and pain-free elite swimmers. Am J Sports Med. 1997;25:454-9. 15) Dauty M, Dominique H, Héléna A, Charles D. Evolution of the isokinetic torque of shoulder rotators before and after 3 months of shoulder stabilization by the Latarjet technique. Ann Readapt Med Phys. 2007;50:201-8. 16) Codine P, Bernard PL, Pocholle M, Benaim C, Brun V. Influence of sports discipline on shoulder rotator cuff balance. Med Sci Sports Exerc. 1997;29:1400-5. 17) Plotnikoff NA, MacIntyre DL. Test-retest reliability of glenohumeral internal and external rotator strength. Clin J Sport Med. 2002;12:367-72. 18) Wilk KE, Arrigo CA, Davies G. Isokinetic testing and rehabilitation of microtraumatic shoulder injuries. In: Davies GJ, ed. Onalaska, WI: S & S Publishers; 1992. 387-431. 19) Dvir Z. Isokinetics of the shoulder muscles. 2nd ed. Edinburgh: Churchill Livingstone; 2004. 213-33. 20) Mayhew JL, Piper FC, Ware JS. Anthropometric correlates with strength performance among resistance trained athletes. J Sports Med Phys Fitness. 1993;33: 159-65. 21) Edouard P, Frize N, Calmels P, Samozino P, Garet M, Degache F. Influence of rugby practice on shoulder internal and external rotators strength. Int J Sports Med. 2009;30:863-7. 22) Ellenbecker TS, Davies GJ. The application of isokinetics in testing and rehabilitation of the shoulder complex. J Athl Train. 2000;35:338-50. 23) Ivey FM, Jr., Calhoun JH, Rusche K, Bierschenk J. Isokinetic testing of shoulder strength: normal values. Arch Phys Med Rehabil. 1985;66:384-6. 24) Edouard P, Degache F, Beguin L, et al. Rotator cuff strength in recurrent anterior shoulder instability. J Bone Joint Surg Am. 2011;93:759-65. 84
이동기 : 등속성검사를통한견관절전방불안정환자와정상인의회전력비교 초록 목적 : 견관절전방불안정환자는탈구에대한불안감및탈구시의통증등다양한원인으로정상적인운동및활동을하지못할것으로예상할수있으나이에대한연구는미미한실정이다. 본연구에서는견관절전방불안정환자와정상인사이의내회전및외회전력에대해등속성근력검사를시행하여전방불안정환자에서나타나는회전력의변화를살펴보고자하였다. 대상및방법 : 2009년 3월부터 2010년 2월까지우측우세수의견관절전방불안정진단하에수술적치료를시행한환자중수술전등속성근력검사를시행한환자 13 명을대상으로하였고, 견관절의전방불안정증상이없는정상성인 15 명을대조군으로설정하였다. 대상군및대조군모두남성이었으며두군간의평균연령, 신장, 체중, 체질량등의차이는없었다. 등속성근력검사는 Biodex system (Biodex Medical Systems, Shirley, NY, USA) 을사용하여 60 deg/sec, 180 deg/sec 의각속도로견관절의외회전력및내회전력의체중보정최대우력 (peak torque) 과총일량을측정하였고, 외회전, 내회전최대우력비율및운동피로도를계산하였다. 두군간에각측정치를비교하여전방불안정환자의회전력의특징을분석하였다. 결과 : 불안정증이없는좌측견관절의등속성회전근력은양군사이에모든측정치에서차이가없었다. 우측견관절의등속성근력검사결과내회전력은전방불안정환자와정상대조군간모든각속도에서최대우력및총일량사이에유의한차이가없었다. 외회전력의체중보정최대우력과총일량은전방불안정환자에서 60 deg/sec 및 180 deg/sec 두각속도에서모두정상대조군에비하여감소되었고, 외회전력 / 내회전력의최대우력비율역시통계적차이가있었다. 운동피로도는외회전력, 내회전력모두양군간에의미있는차이는없었다. 결론 : 견관절전방불안정환자는견관절의외회전력이감소되어있고내회전-외회전력의균형이소실되어있으나근피로도는정상으로판단되며이는견관절탈구환자의보존적치료나재활에있어고려해야할것으로생각된다. 색인단어 : 견관절, 전방불안정, 등속성근력검사 85