Do razdora glenoidnog labruma obično dolazi zbog specifične traume kao što je pad na ispruženu ruku. Razdor također može nastati iz kroničnih pokreta rukom iznad glave, kao kod bacanja. Razdor glenoidnog labruma uzrokuje bol tijekom gibanja. Liječi se fizikalnom terapijom, a ponekad kirurški.
Rame (za razliku od kuka ili koljena) je nestabilan zglob; opisuje se kao golf loptica koja stoji na postolju. Kako bi se poboljšala strukturalna stabilnost, glenoid (anatomski vrlo plitka čašica) je produbljen labrumom, koji je građen od gumastog vezivno–hrskavičnog tkiva oko ruba glenoidne fose. Do njegovog razdora može doći tijekom bavljenja sportovima u kojima dolazi do bacanja ili uslijed tupe traume pri padu i dočekivanju na ispruženu ruku.
Simptomi i znakovi
Simptomi i znakovi razdora glenoidnog labruma.
Razdor glenoidne fose rezultira dubokom boli u ramenu tijekom pokreta, pogotovo prilikom bacanja loptice. Ova nelagoda može biti popraćena bolnim osjećajem škljocanja i uklještenja u ramenu.
Dijagnoza
Dijagnoza razdora glenoidnog labruma
U početku treba izvršiti detaljan pregled ramena i vrata no često bolesnika treba uputiti specijalisti jer se patologija promjene često može odrediti samo profinjenijim dijagnostičkim pretragama (npr. MR s kontrastom).
Liječenje
Liječenje razdora glenoidnog labruma
Fizikalna terapija je početno liječenje. Ako nakon fizikalne terapije ne dođe do poboljšanja simptoma, a dijagnoza se potvrđuje pomoću MR, liječenje izbora je često kirurška nekrektomija ili popravak. Zahvat se obično izvodi artroskopski.
Vježbe za stabilizaciju ramenog zglobaProne Shoulder Extension
1. Lie on stomach with involved arm hanging off edge of bed with thumb pointed out away from body.
2. Keep elbow straight and extend arm to trunk level while squeezing the scapula down and back.
3. Return to starting position.
4. Perform 3 sets of 10 repetitions.
5. Add light weight as tolerated.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Sidelying Shoulder External Rotation
1. Lie on uninvolved side with pillow between arm and body of the involved side.
2. Bend involved elbow to 90°.
3. Prepare the scapula by retracting and depressing (squeezing toward spine and downward).
4. Move forearm up by rotating at the shoulder, so the back of the hand is up toward the ceiling.
5. Slowly return to start position and repeat.
6. Perform 3 sets of 10 repetitions, 1 time a day.
7. Add light weight as tolerated.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Prone Shoulder Horizontal Abduction
1. Lie on stomach with involved arm down off edge of table and thumb pointed out away from body.
2. Retract and depress the scapula (squeeze toward spine and downward).
3. Lift arm upward to shoulder level.
4. Lower arm toward the floor and repeat.
5. Perform 3 sets of 10 repetitions, 1 time a day.
6. Special Instructions
a. Do not let shoulder blade move when lifting arm.
b. Keep thumb facing up toward the ceiling.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Prone Shoulder Horizontal Abduction with External Rotation
1. Lie on stomach with involved arm out to the side, off edge of bed and elbow bent to 90°.
2. Forearm should be off edge of bed with thumb toward the body.
3. Retract and depress the scapula (squeeze toward spine and downward).
4. Rotate forearm upward.
5. Return to start position and repeat.
6. Perform 3 sets of 10 repetitions, 1 time a day.
7. Special Instructions
a. Do not let shoulder blade move when lifting forearm.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Shoulder Scaption
1. Begin with arm at side, keep elbow straight and thumb up.
2. Move arm forward in position approximately 30° to be in the place of the scapula or scaption.
3. In this position raise arm up staying in a pain-free range.
4. Return to starting position.
5. Perform 3 sets of 10 repetition, 1 time a day.
6. Add light weight as tolerated.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Resisted Shoulder External Rotation
1. Place band to secure object at waist level.
2. Place pillow or towel roll between elbow and body on involved side.
3. Grasp band in involved hand, with elbow bent to 90° and thumb up.
4. Externally rotate arm, then slowly return to start position.
5. Perform 3 sets of 10 repetitions, 1 time a day.
6. Special Instructions
a. Start with least resistance band.
b. Keep arm at side and elbow flexed at 90°.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Resisted Shoulder Internal Rotation
1. Place band to secure object at waist level.
2. Place pillow or towel roll between elbow and body on involved side.
3. Grasp band with involved hand, with elbow bent to 90° and thumb up.
4. Internally rotate arm (pull hand inward across body), then slowly return to start position.
5. Perform 3 sets of 10 repetitions, 1 time a day.
6. Special Instructions
a. Start with least resistance band.
b. Keep arm at side and elbow flexed at 90°.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Resisted Bent-Over Row
1. Hold weight in hand on involved side.
2. Slightly bend hips and knees and support upper body with other hand placed on table or bed.
3. Bend elbow to 90° and extend shoulder to raise elbow to shoulder height by retracting (squeezing) the scapula.
4. Return to start position.
5. Perform 3 sets of 10 repetitions, 1 time a day.
6. Special Instructions
a. Start with 1 to 2 pound (0.5 to 1 kg) weight (ie, a soup can).
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.