Obere Extremität

, Volume 8, Issue 3, pp 164–169 | Cite as

Die schmerzhafte Werferschulter: evidenzbasiertes Übungsprogramm bei Skapuladyskinesie

Übersicht
First Online:
Received:
Accepted:

Zusammenfassung

Die Position und Bewegung des Schulterblatts ist ein Schlüsselelement für einen harmonischen Bewegungsablauf des Armes. Ein Abheben und eine Fehlrotation des Schulterblatts wird als Skapuladyskinesie bezeichnet. Sie kann auch bei beschwerdefreien Personen auftreten. Bei intensiver sportlicher Belastung kann allerdings eine Skapuladyskinesie die Sehnenstrukturen durch den gestörten Bewegungsablauf belasten und reizen, was zu Schmerzen führt. Deshalb sind die Harmonisierung der Skapulabewegung und die Stabilisierung des Schulterblatts wichtige Pfeiler zur Regeneration entzündeter Schulterstrukturen (z. B. Bizepssehne, Rotatorenmanschette). Elektrophysiologische Untersuchungen zeigen, dass die skapulastabilisierende Muskulatur effektiv trainiert werden kann. Diese Übungen wurden in ein stufenförmiges Programm integriert, das im Artikel vorgestellt wird: Die Basis aller Übungen ist eine optimale Rumpfstabilität. Darauf aufbauend werden die Eigenwahrnehmung, die Stabilisierung und gezielte translatorische Bewegung in isometrischen Übungen trainiert. Sofern diese Übungen schmerzfrei durchführbar sind, werden auch komplexe dynamische Bewegungen geübt, um schlussendlich die sportartspezifischen Bewegungen zu integrieren.

Schlüsselwörter

Schulter Skapuladyskinesie Wurfsportler Impingement Trainingsprogramm 

Shoulder pain in overhead throwing athlete: an evidence-based training program for treating scapula dyskinesis

Abstract

A key element for a harmonic movement of the arm is the position and motion of the scapula. A pathologic position and movement of the scapula what is called scapula dyskinesia may irritate the tendons and cause pain in high performing athletes. Scapula dyskinesia, however, may also occur in asymptomatic patients. Harmonizing the sequence of movements and restoration of the dynamic scapular stability are basic steps to regenerate the irritated tendons (e.g. biceps tendon, rotator cuff). Electrophysiological studies have shown that the scapula stabilizing muscles can effectively be exercised. These exercises are part of a step by step program which is described in this article. In the first place, core stability is essential. Furthermore, proprioception, stability and translational movement exercises are in the focus initially. If these exercises can be performed without pain, complex movements and finally sports specific exercises are added.

Keywords

Shoulder Scapula dyskinesis Throwing athlete Impingement Training 
This is a preview of subscription content, log in to check access.

Literatur

  1. 1.
    Altcheck DW, Levinson M (2000) The painful shoulder in the throwing athlete. Orthop Clin North Am 31:241–245PubMedCrossRefGoogle Scholar
  2. 2.
    Axe MJ (1994) Evaluation and treatment of common throwing injuries of the shoulder and elbow. Del Med J 59:593–598Google Scholar
  3. 3.
    Baeyer CL (1994) Reactive effect of measurement of pain. Clin J Pain 10:18–21CrossRefGoogle Scholar
  4. 4.
    Baskurt Z, Baskurt F, Gelecek N, Ozkan MH (2011) The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 24:173–179PubMedGoogle Scholar
  5. 5.
    Bennett GE (2012) Shoulder and elbow lesions distinctive of baseball players. 1947. Clin Orthop Relat Res 470:1531–1533PubMedCrossRefGoogle Scholar
  6. 6.
    Brumitt J, Dale RB (2009) Integrating shoulder and core exercises when rehabilitating athletes performing overhead activities. N Am J Sports Phys Ther 4:132–138PubMedGoogle Scholar
  7. 7.
    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19:404–420PubMedCrossRefGoogle Scholar
  8. 8.
    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 19:641–661PubMedCrossRefGoogle Scholar
  9. 9.
    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19:531–539PubMedCrossRefGoogle Scholar
  10. 10.
    Castagna A, Garofalo R, Cesari E et al (2010) Posterior superior internal impingement: an evidence-based review (corrected). Br J Sports Med 44:382–388PubMedCrossRefGoogle Scholar
  11. 11.
    Cools AM, Dewitte V, Lanszweert F et al (2007) Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med 35:1744–1751PubMedCrossRefGoogle Scholar
  12. 12.
    Ekstrom RA, Donatelli RA, Carp KC (2007) Electromyographic analysis of core trunk, hip, and thigh muscles during 9 rehabilitation exercises. J Orthop Sports Phys Ther 37:754–762PubMedCrossRefGoogle Scholar
  13. 13.
    Ellenbecker TS, Kibler WB, Bailie DS et al (2012) Reliability of scapular classification in examination of professional baseball players. Clin Orthop Relat Res 470:1540–1544PubMedCrossRefGoogle Scholar
  14. 14.
    Ellenbecker TS, Roetert EP, Bailie DS et al (2002) Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc 34:2052–2056PubMedCrossRefGoogle Scholar
  15. 15.
    Ellenbecker TS, Roetert EP, Piorkowski PA, Schulz DA (1996) Glenohumeral joint internal and external rotation range of motion in elite junior tennis players. J Orthop Sports Phys Ther 24:336–341PubMedCrossRefGoogle Scholar
  16. 16.
    Fink C, Melchert M, Hillekamp J et al (2011) Akute und chronische anterioinferiore Schultergelenkinstabilität. Obere Extremität 6:217–223Google Scholar
  17. 17.
    Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF (1995) Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 23:233–239PubMedCrossRefGoogle Scholar
  18. 18.
    Gokeler A, Lehmann M (2004) Die Rolle der Skapula bei der instabilen Schulter. Arthroskopie 17:199–205CrossRefGoogle Scholar
  19. 19.
    Hong J, Barnes MJ, Leddon CE et al (2011) Reliability of the sitting hand press-up test for identifying and quantifying the level of scapular medial border posterior displacement in overhead athletes. Int J Sports Phys Ther 6:306–311PubMedGoogle Scholar
  20. 20.
    Jazrawi LM, McCluskey GM III, Andrews JR (2003) Superior labral anterior and posterior lesions and internal impingement in the overhead athlete. Instr Course Lect 52:43–63PubMedGoogle Scholar
  21. 21.
    Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev 18:963–975PubMedGoogle Scholar
  22. 22.
    Jobe FW, Pink M (1993) Classification and treatment of shoulder dysfunction in the overhead athlete. J Orthop Sports Phys Ther 18:427–432PubMedCrossRefGoogle Scholar
  23. 23.
    Jobe FW, Tibone JE, Perry J, Moynes D (1983) An EMG analysis of the shoulder in throwing and pitching. A preliminary report. Am J Sports Med 11:3–5PubMedCrossRefGoogle Scholar
  24. 24.
    Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11:142–151PubMedGoogle Scholar
  25. 25.
    Kibler WB, McMullen J, Uhl T (2001) Shoulder rehabilitation strategies, guidelines, and practice. Orthop Clin North Am 32:527–538PubMedCrossRefGoogle Scholar
  26. 26.
    Kibler WB, Press J, Sciascia A (2006) The role of core stability in athletic function. Sports Med 36:189–198PubMedCrossRefGoogle Scholar
  27. 27.
    Kibler WB, Sciascia A (2010) Current concepts: scapular dyskinesis. Br J Sports Med 44:300–305PubMedCrossRefGoogle Scholar
  28. 28.
    Kibler WB, Sciascia A, Wilkes T (2012) Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orthop Surg 20:364–372PubMedCrossRefGoogle Scholar
  29. 29.
    Kibler WB, Sciascia AD, Uhl TL et al (2008) Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med 36:1789–1798PubMedCrossRefGoogle Scholar
  30. 30.
    Kirchhoff C, Imhoff AB (2010) Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes-evolving concepts. Int Orthop 34:1049–1058PubMedCrossRefGoogle Scholar
  31. 31.
    Krishnan SG, Hawkins JR, Warren RF (2004) The shoulder and the overhead athlete. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  32. 32.
    Lombardo SJ, Jobe FW, Kerlan RK et al (1977) Posterior shoulder lesions in throwing athletes. Am J Sports Med 5:106–110PubMedCrossRefGoogle Scholar
  33. 33.
    Ludewig PM, Hoff MS, Osowski EE et al (2004) Relative balance of serratus anterior and upper trapezius muscle activity during push-up exercises. Am J Sports Med 32:484–493PubMedCrossRefGoogle Scholar
  34. 34.
    Ludewig PM, Phadke V, Braman JP et al (2009) Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg Am 91:378–389PubMedCrossRefGoogle Scholar
  35. 35.
    Ludewig PM, Reynolds JF (2009) The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 39:90–104PubMedCrossRefGoogle Scholar
  36. 36.
    Maenhout A, Van PK, Pizzi L et al (2010) Electromyographic analysis of knee push up plus variations: what is the influence of the kinetic chain on scapular muscle activity? Br J Sports Med 44:1010–1015PubMedCrossRefGoogle Scholar
  37. 37.
    McClure P, Balaicuis J, Heiland D et al (2007) A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther 37:108–114PubMedCrossRefGoogle Scholar
  38. 38.
    McClure P, Greenberg E, Kareha S (2012) Evaluation and management of scapular dysfunction. Sports Med Arthrosc 20:39–48PubMedCrossRefGoogle Scholar
  39. 39.
    McClure P, Tate AR, Kareha S et al (2009) A clinical method for identifying scapular dyskinesis, part 1: reliability. J Athl Train 44:160–164PubMedCrossRefGoogle Scholar
  40. 40.
    McMullen J, Uhl TL (2000) A kinetic chain approach for shoulder rehabilitation. J Athl Train 35:329–337PubMedGoogle Scholar
  41. 41.
    Mikail SF, Deursen J van, Baeyer CL (1986) Rating pain or rating serenity: effects on cold pressor pain tolerance. Can J Beh Sci 18:126–132CrossRefGoogle Scholar
  42. 42.
    Odom CJ, Taylor AB, Hurd CE, Denegar CR (2001) Measurement of scapular asymetry and assessment of shoulder dysfunction using the Lateral Scapular Slide Test: a reliability and validity study. Phys Ther 81:799–809PubMedGoogle Scholar
  43. 43.
    Rutjes AW, Reitsma JB, Di NM et al (2006) Evidence of bias and variation in diagnostic accuracy studies. CMAJ 174:469–476PubMedGoogle Scholar
  44. 44.
    Rutjes AW, Reitsma JB, Vandenbroucke JP et al (2005) Case-control and two-gate designs in diagnostic accuracy studies. Clin Chem 51:1335–1341PubMedCrossRefGoogle Scholar
  45. 45.
    Sethi PM, Tibone JE, Lee TQ (2004) Quantitative assessment of glenohumeral translation in baseball players: a comparison of pitchers versus nonpitching athletes. Am J Sports Med 32:1711–1715PubMedCrossRefGoogle Scholar
  46. 46.
    Shadmehr A, Bagheri H, Ansari NN, Sarafraz H (2010) The reliability measurements of lateral scapular slide test at three different degrees of shoulder joint abduction. Br J Sports Med 44:289–293PubMedCrossRefGoogle Scholar
  47. 47.
    Tate AR, McClure P, Kareha S et al (2009) A clinical method for identifying scapular dyskinesis, part 2: validity. J Athl Train 44:165–173PubMedCrossRefGoogle Scholar
  48. 48.
    Uhl TL, Kibler WB, Gecewich B, Tripp BL (2009) Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy 25:1240–1248PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Schulter- und Ellenbogenchirurgie, Sportorthopädie, Klinik und Poliklinik für OrthopädieUniversitätsklinikum Carl Gustav Carus DresdenDresdenDeutschland

Personalised recommendations