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Shoulder injury: damage to cuff of the shoulder joint A shoulder injury is most often seen in the form of intense pain, sometimes swelling, and impaired performance of the entire hand. Why? The fact that the shoulder joint is the most moveable in the body. Thanks to the functionality of the shoulder joint of the human hand is able to perform many actions on a daily basis in everyday life. The shoulder is capable of movement in all planes, but if you increase the load on it there are various injuries and degenerative changes. The repeated stress on the shoulder joint loses its stability, and there are problems with performance. The shoulder of the person has its own structure, which includes the rotator cuff. In addition to bones and connective tissue, the shoulder characterized by the presence of muscles and tendons that serve. Together they create a performance of the shoulder. These include the infraspinatus, supraspinatus, subscapularis and small round muscles. What may occur the injury? Trauma may occur from damage to bones of the shoulder. It is known that 3 bones: glenoid cavity of scapula, clavicle, and humeral head bone affect the function of entire hand. Thanks to the durable connective tissue of all the bones remain in his position. As for cuffs, each muscle also has its purpose. For example, the subscapularis muscle helps to make a rotational movement inside, and the supraspinatus is responsible for lifting the arm and its fixing (i.e., fixing the shoulder joint) in a specific position. Supraspinatus muscle acts as a guide, while the deltoid determines the strength of shoulder abduction. Speaking about the function of the infraspinatus component of the rotator cuff of the shoulder joint, it is responsible for outward movement. One muscle performs the same task, but also helps in the movement of the hands towards the torso. This is a small round muscle. Together, they provide a shoulder. Symptoms of damage to the shoulder joint Injury of the shoulder joint or trauma is always accompanied by pain. Depending on the severity of the destruction of the rotator cuff of the shoulder joint pain can be intense and aching. The pain occur due to how serious the gap. It can be partial or complete. This means how much the tendon of the muscle was separated from its anatomical position. The symptoms are often pronounced: pain, weakness of hands, sometimes a complete loss of function. Another feature of the cuff injuries the shoulder joint is that people can’t sleep on the sick side. Damage to the rotator cuff of the shoulder joint: causes Trauma to the shoulder joint or injury — causes is quite common. However, they are not the only one. There are many other factors that provoke problems with the shoulder. The rotator cuff is a muscle tendon, which are insufficiently supplied with blood. Thus, due to poor circulation occurs teknopatia. It is a kind of degenerative changes to the joints of the shoulder. Some doctors refute this fact, because they believe that blood supply does not affect the state of the structure of the shoulder joint. Instead, they suggest that most of the problems with the rotator cuff due to genetics. That is, if a person has a hereditary pathology of the connective tissue, most likely, to it not to avoid problems with rotational cuff of the shoulder joint. Typically, the connective tissue contains a special kind of protein. Collagen (protein) is of 4 types. If the percentage of protein 3 or 4 types is elevated, then the development of rinopatii accelerating. As practice shows, the disease can develop in any tendon of the rotator cuff. The person feels great pain when starting to move. If there is teknopatia the supraspinatus tendon, the patient is experiencing pain when the hand is moved in the lateral direction. If damage to the rotator cuff of the shoulder joint accounts for the subscapularis tendon, the pain bother you during grooming or when hold the fork/spoon to your mouth. Often, doctors call it a frozen shoulder, which is incorrect. This is a different disease, moreover, the symptoms and treatment varies. Shoulder pain — a common symptom of many diseases of this joint. However, each pathology seen and treated in different ways. Tenopathy can provoke prolonged use of multiple antibiotics. This is one of the most common reasons for the development of the disease. Other important causes are repeated trauma that occurs in two possible options: With age genetic diseases do not go away. This also applies to the rotator cuff of the shoulder joint. With age the tendons weaken, and even a small injury, not to mention the fracture or dislocation (damage bankart) that can lead to rupture. The shoulder in this case will require the right treatment, or to recover anything already will not work. So if you have a predisposition to such illnesses, be sure to promptly attend a specialist. Remember that the gap could be when a young man. Statistics show that the average age of people suffering from problems of the rotator cuff is 36-55 years. Injury of the rotator cuff and diagnostics First of all, when you visit your doctor doctors will give an oral survey. They ask about old injuries, mechanism of injury. Then the sore shoulder will have to make a few moves. If the tear is partial then movement is possible, but gives pain. If there is a complete gap, so the hand can perform certain movements. Muscles and tendons are damaged and lost efficiency. You need to pass x-rays to identify the location of the injury and its severity. In some cases, to confirm diagnosis and to determine the extent of the damage, the patient undergoes ultrasound examination. In addition, a possible MRI. Thus, after passing all examinations the doctor makes a diagnosis and prescribes treatment. Treatment of the shoulder joint When is the acute phase of the disease, therapy, pain medication, as pain are frequent and intense. If the gap is found incomplete, the hand should be quiet. You can make a bandage, so as not to injure the affected area. If the pain is decreased, it is necessary to strengthen the muscles, but this should be done gradually. The physical exercises prescribed by the doctor and usually run until 8 weeks. To relieve pain and reduce swelling, apply ice. Treatment of folk remedies involves making healing herbal tinctures (which have sedative and anti-inflammatory action) and baths made of pine cones. The operation is assigned only if: Surgery is not always successful. The restoration of the rotator cuff of the shoulder joint in individual cases is not possible if the tendon is completely torn. The surgery itself is a complex process. Rehabilitation lasts a long time.
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Sekundarna prevencija ramenog zgloba na TRX pomagalu TEMELJNI PODATCI IZ FUNKCIONALNE ANATOMIJE Kad kažemo „rameni zglob“ najčešće mislimo na zglob izmeđuglave humerusa i glenoida scapule, art. glenohumeralis, iako je on samo jedan od četiri zgloba ramenog obruča koji funkcioniraju kao jedna cjelina. To su još akromioklavikularni zglob, sternoklavikularni zglob i skapulotorakalni zglob. Najveći i najvažniji zglob ramenog obruča je glenohumeralni zglob. Konkavno je zglobno tijelo cavum glenoidale na scapuli,a konveksno je zglobno tijelo glava humerusa. Cavum glenoidale je izrazito plitak u odnosu na konveksitet glave humerusa. To je razlog osjetne nestabilnosti tog zgloba. Zglobovi ramenog obruča su pokriveni jakim mišićima i ti mišići tvore tzv. rotatornu manšetu. Mišići koji tvore rotatornu manšetu su: m. subscapularis- unutarnji rotator i adductor; m. supraspinatus- abduktor i izvanjski rotator; m. infraspinatus- vanjski rotator; m. teres minor- izvanjski rotator. Osim ovih mišića ramenom zglobu pripada i još nekoliko mišića koji su zaduženi za stabilnost i funkciju ramenog obruča. To su: m. deltoideus- abduktor ramena; pectoralis maior- unutarnji rotator nadlaktice; pectoralis minor- zaslužan je za stabilizaciju scapule; m. teres maior- unutarnji rotator; m. biceps brachi koji stabilizira glavu humerusa u glenoidu scapule i m. triceps brachi njegova funkcija je da adducira rame. BIOMEHANIKA RAMENA Kao što smo već spomenuli rameni zglob je složen zglob, sastoji se od četiri zgloba, najvažniju ulogu i funkciju ima glenohumeralni zglob. To je zglob s tri i više osovina (art. spheroidea) i u njemu su moguće kretnje: antefleksije i retrofleksije, abdukcije i adukcije unutarnje i vanjske rotacije te cirkumdukcije. Kretnje su iste kao i u zglobu kuka, ali su po opsegu veće nego u kuku zbog plitkoće konkavnog zglobnog tijela. Zbog izrazito slabih mehaničkih sila koje djeluju na zglobne plohe ramena, rameni zglob se znatno manje troši od npr. zgloba kuka. Pak, s druge strane radi velikog opsega kretanja u ramenom zglobu, rame je izloženo drugim velikim oštećenjima i promjenama. Rame se sastoji od četiri zgloba i oštećenje u bilo kojem od četiri zgloba rezultira ukupnom smanjenošću opsega pokreta u ramenu. NESTABILNOST RAMENA Kada govorimo o nestabilnosti ramena tada mislimo na nestabilnost glenohumeralnog zgloba, koji je najnestabilniji zglob u ljudskom tijelu. Oko 50% svih iščašenja zglobova otpada na rameni zglob. Razlog tome je već spomenuto plitko konkavno zglobno tijelo (cavum glenoidale) i relativno veliko konveksno zglobno tijelo (glava humerusa), te labavi ligamenti oko ramenog zgloba. S obzirom u kakvom su kontaktu konveksno i konkavno zglobno tijelo govorimo o subluksaciji (nepotpunom iščešenju) i luksaciji (potpunom iščešenju) zgloba. Kod subluksacije zgloba glava humerusa pri pojedinim pokretima pobjegne iz glenoida pa se vrati. Kod luksacije glava humerusa više nije u kontaktu s cavum glenoidale, konkavno i konveksno zglobno tijelo su izgubili sav kontakt. Luksacije koje su posljedica traume zovu se traumatske luksacije, a ostatak luksacija ramena otpada na tzv. atraumatske luksacije, one nastaju bez većih trauma, posljedica su izvedbe određenog pokreta npr. bacanje koplja, bacanje kugle, plivanja, igranja odbojke,… Atraumatske luksacije ramena se liječe konzervativno, jačanjem mišića ramenog obruča, u slučaju da konzervativno liječenje ne daje rezultate tada treba prijeći na operacijsko liječenje. OZLJEDA (RUPTURA) ROTATORNE MANŠETE Već smo spomenuli mišiće koji čine rotatornu manšetu: subscapularis, supraspinatus, infraspinatus, teres minor. Ti mišići imaju važnu ulogu pri stabilizaciji ramenog zgloba. Međutim, česte i ponavljane kretnje u glenohumeralnom zglobu, osobito kretnje abdukcije, mogu oštetiti rotatornu manšetu pritiskajući je i gnječeći je između velikog tuberkula humerusa i akromiona, odnosno korakoakromijalnog ligamenta. Na rotatornoj manšeti postupno nastaju degenerativne promjene te eventualna trauma ramena. U prvoj fazi nastaje edem područja rotatorne manšete. S vremenom nastaje upalna reakcija i fibroza vezivnotetivnih struktura te degenerativne promjene velikog tuberkula i akromiona. Fibrozno i degenerativno promijenjena rotatorna manšeta podložna je pucanju (rupturi) i kod minimalne traume, poznato kao „ruptura rotatorne manšete.“ (Erceg M., 2006). Ruptura može biti akutna i kronična, te djelomična i potpuna. Akutna ruptura rotatorne manšete je dosta rijetka, a javlja se u mlađih ljudi koji su doživjeli traumu ramena. Kronična ruptura rotatorne manšete je češća i posljedica je degeneracije zglobne čahure i njezinih tetivnih pojačanja te i najmanja trauma može dovesti do puknuća, odnosno rupture. Ona se događa kod starijih bolesnika, obično iza 60. godine života. S obzirom na to kolika je ruptura po debljini govorimo o djelomičnoj (parcijalnoj) ili potpunoj rupturi rotatorne manšete. Kada govorimo o djelomičnoj rupturi tada ne postoji totalni prekid duž cijele zglobne čahure i mišićnih tetiva, dok kod potpune rupture rotatorne manšete je došlo do totalnog pucanja cijele debljine tetiva i zglobne čahure. Liječenje rupture rotatorne manšete može biti operacijsko i konzervativno, zavisno o veličini i vrsti ozljede, (akutna ili kronična ruptura, djelomična ili potpuna), tegobama bolesnika, životnoj dobi bolesnika. Akutne rupture rotatorne manšete i kronične potpune rupture u aktivnijih mlađih bolesnika treba liječiti operacijski. Djelomične rupture koje bolesniku ne smetaju, u situacijama gdje bolesnik i dalje može obavljat različite zadatke s tim ramenom, liječe se konzervativno. Kretnje pri kojima bolesnik osjeća bolove u ramenu treba izbjegavati. Korisno je izvoditi vježbe istezanja i jačanja mišića rotatorne manšete. PROGRAM SEKUNDARNE PREVENCIJE ROTATORNE MANŠETE NA TRX-u Prikazane vježbe izvode se na način da se progresivno povećava otpor odnosno težina vježbe. To se izvodi na način da se podvlači nogama pod TRX i time se smanjuje kut te povećava otpor koji je potrebno savladati. Prikazani program vježbi preporučuje se koristiti u vremenu od četri tjedna odnosno dvanaest treninga, sa brojem ponavljanja od 10 do 15 repeticija u 3 do 5 serija. Vježbe su usmjerene k jačanju rotatorne manšete (m. pectoralis major, m. deltoideus, m. trapezius i m. teres major). ZAKLJUČAK Različito inicijalno stanje svake osobe zahtjeva individualni pristup provođenja prikazanoog programa. Kako se navodi ranije u tekstu rameni zglob je najnestabilniji zglob u našem tijelu te svakako pri provođenju ovog programa treba biti iznimno oprezan. Na temelju praktične primjene ovog programa pokazao se veoma učikovit za stabilsnost i jačanje ramenog obruča. Mogućnost progresivnog povećanja otpora omogućuje konstatni napredak, a pri tom se smanjuje mogućnost ozljede ramenog zgloba. LITERATURA - Carodoso de Souza M., Trajano Jorge R., Jones A., Lombardi Junior I., Natour J. Progressive resistance training in patients with shoulder impingement sondrome. Reumatismo, 84-9. Ortopedija-za studente medicine. Sveučilište u Splitu. - Frederic D., (2001). Strenght training anatomy. Paris. Human Kinetics. - Ludewig PM., Cook TM., (2000). Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical therapy, 276-91. Autori: Anić-Kremić Marijo, Kulušić Fedor, Medaković Bojan PREGLEDAJTE I PREUZMITE KATALOG S NAŠOM KOMPLETNOM PONUDOM! Iz ponude ovog puta izdvajamo Fitball Antiburst od 65 ili 75 cm, Trake za trening s vlastitom težinom, Balans poluloptu Pro-Line i Power Wheel Deluxe. Svu ostalu ponudu sportske opreme možete provjeriti na našem webshopu, a pratite nas i putem Facebooka i Twittera. - Sekundarna prevencija ramenog zgloba na TRX pomagalu - 29. prosinca 2014 - Stabilizacija trupa – Stipe Bekavac - 21. studenoga 2014 - Razvoj koordinacije tenisača - 10. studenoga 2014