RU2367400C1 - Therapy of muscular scapulohumeral periarthritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to manual therapy, orthopaedics, neurology, physiotherapy exercises. All humeral motion planes are examined to determine a direction of locking by spasm pain muscles. The spasm muscle antagonists are chosen and statically extended from bone attachment points along a fibre sequentially for each muscle as follows: rotation, flexion - extension, abduction - adduction in all humeral motion planes. The antagonists are extended 3-5 times per one procedure. Then a muscular fibre of each muscle is extended in motion oppositely to directions wherein "pain syndrome" is perceptible, sequentially as follows: rotation, flexion - extension, abduction - adduction in all humeral motion planes 3-5 times per one procedure.

EFFECT: method provides early mobilisation of patients, reduced cost of treatment, reduced injuries and treatment time.

2 tbl, 2 ex

Description

The invention relates to medicine, namely to manual therapy, orthopedics, neurology, physiotherapy exercises, and can be used in the treatment of shoulder-shoulder periarthritis.

A known method of treating patients with joint contractures, including conducting mechanical vibration of the affected area and physiotherapy exercises. At the same time, traction is carried out, and mechanical vibration is carried out with a gradual increase in the amplitude of oscillations from 0.3-0.5 to 2.0-3.0 mm. In this case, stretching is carried out by increasing the mass of the cargo from 0.1-0.5 to 3.0-5.0 kg, depending on the size of the joint with a duration of one procedure of 10-15 minutes daily (USSR copyright certificate No. 1804819, class A61N 23 / 00 Publish. March 30, 93 Bul. No. 12).

The disadvantage of this method is the need for a special device, a gradual increase in mobility in the joint, a large number of procedures.

There is also known a method for the treatment of humeroscapular periarthritis, including exposure in the acute period to the area of the shoulder joint by physiotherapy and chipping with drugs to relieve pain, followed by physiotherapy in order to consolidate the therapeutic effect (V. Dubrovsky Medical Physical Culture. - M .: Publishing House -to "VLADAS", 2001, p. 291-292).

But this method is invasive (drug chipping), long-term and is not a monotherapy method. In addition, there is a danger of purulent inflammation of the soft tissues of the shoulder joint.

Closest to the proposed in its technical essence is a method for the treatment of shoulder-shoulder periarthritis, including exposure in the acute period to the area of the shoulder joint and ensuring the involvement of the latissimus dorsi, flexors of the forearm, extensors of the shoulder, supraspinatus, coraco-humeral, supraspinatus and deltoid muscles of the shoulder, bringing the arm up to the side, then lowering the arm down and raising the straight arm as high as possible, lowering the arm down and rotation (RF patent No. 2228778, CL A63B 21/00, A63B 23/12. Publ. 20.05.2004).

However, it has several drawbacks: stretching spasmodic muscles and relieving spasm by overworking the receptor apparatus (due to microcracks and, consequently, increasing blood supply) is a very painful procedure and requires the use of non-steroidal anti-inflammatory drugs, as well as the active participation of the patient and the presence of special devices .

The problem to which the invention is directed is to increase efficiency, reduce morbidity and the duration of treatment.

The problem is solved in that in a method for the treatment of humeroscapular periarthritis, including exposure in the acute period to the area of the shoulder joint and ensuring the involvement of the latissimus dorsi, flexors of the forearm, extensors of the shoulder, supraspinatus, coraco-humeral, supraspinatus and deltoid muscles of the shoulder, arm abduction to the side up, then lowering the arm down and raising the straight arm as high as possible, lowering the arm down and rotation, determine the direction of restriction in all planes of movement of the shoulder joint its mobility with spasmodic muscles and antagonist muscles are chosen spasmodic, i.e. pain, muscles, antagonist muscles are stretched in statics along their fibers for the points of attachment to the bones, alternately in the following sequence: rotation, flexion-extension, abduction-reduction in all planes of the shoulder joint movements for each muscle, repeat the stretching of the antagonist muscles 3- 5 times per procedure, after which each muscle is stretched in motion along its fiber in directions opposite to the directions in which the “pain syndrome” is felt, alternately in the following sequence: rotation, flexion bending, abduction-reduction in all planes of the movements of the shoulder joint 3-5 times per procedure.

The determination in all planes of movement of the shoulder joint of the direction of limitation of its mobility by spasmodic muscles makes it possible to identify in which directions (planes) of motion in the shoulder joint pain and limitation of mobility arise, and which muscle function causes this painful restriction of movement.

The choice of antagonist muscles for spasmodic, painful, muscles serves for further work on them in order to stimulate the central regulatory system, as a result of which the overstretched muscles contract, and the spasmodic, painful muscles relax.

Stretching in the statics of antagonist muscles along their fibers beyond the points of attachment to the bones for each muscle in turn has a stimulating proprioceptive effect on the system of regulation of movements due to four reflexes. When the relaxed muscle is stretched (first reflex), the excitation of homonymous motor neurons and (second reflex) inhibition of motor neurons of the spasmodic, painful muscle is enhanced. In addition, a decrease in the stretching of the spindles of the spasmodic muscle weakens (the third reflex) the excitation of homonymous motor neurons and (the fourth reflex) reciprocal inhibition of the motor neurons of the relaxed muscle (this is called disinhibition). Ultimately, the motor neurons of the relaxed muscle are excited, and spasmodic, painful, will be inhibited. All four reflex arcs together form a system for regulating muscle length and determine the mechanism of the stimulating-relaxing action of remodeling of the motor act.

Repetition of stretching of the antagonist muscles in each plane of movement of this muscle 3-5 times per procedure is optimal and eliminates overwork of the receptor apparatus of the muscle.

The subsequent stretching in the movement of each muscle along its fiber in the directions opposite to the directions in which the “pain syndrome” is felt is necessary to enhance the normalizing work of the regulatory function of the central nervous system.

Stimulated muscle stimulation is carried out in all planes of the shoulder joint movements 3-5 times per procedure alternately in the following sequence: first, all antagonist muscles involved in rotation are stimulated, then those involved in flexion-extension, and then involved in lead-reduction. This sequence was chosen due to the fact that each muscle can participate in several planes of movement of the shoulder joint, i.e. the predominance of one or the other direction of rotation can determine the predominance in the planes of flexion-extension and abduction-reduction.

The technical result consists in the early activation of patients, the use of the claimed method as monotherapy of the shoulder-shoulder periarthritis and in reducing the cost of treatment.

The method is implemented as follows.

In order to determine the direction of limitation of mobility in the shoulder joint due to spasm and pain in the muscles, the hyperfunction of which determines this limitation, the following is carried out: the patient, sitting on a chair, makes active movements in all planes of mobility in the joint in the following sequence: rotation, flexion-extension and reduction-abduction with a little overcoming of the efforts of the doctor directed in the opposite direction. Having determined the direction of restriction of mobility in the planes of movement of the joint, a group of muscles is created that create this restriction. As you know, pain gives a spasmodic muscle due to inflammation. Based on this, determine the set of pathological muscles (table No. 1).

Then, muscle antagonists are selected for muscles with hyperfunction (pain and spasm) also in all planes of mobility in the joint and in the following sequence: rotation, flexion-extension and abduction-reduction (table 1). In the process of selection of antagonist muscles, there may be cases when the antagonist muscle in one plane of joint movement is a pathological muscle in another plane of movement. Then this muscle should be excluded from the list of muscles selected during the selection process. In their work, the inventors used tables of the method of remodeling a motor act in cerebral palsy. The antagonists for muscles with hyperfunction are overstretched muscles, and the method of exposure to them is the stretching method. In this case, the central regulatory mechanisms are turned on, and the overstretched muscle contracts (Bernstein's law). As a result, the muscle, which was in a state of hyper-contraction, experiences inhibitory effects from regulatory systems and, as a result, relaxes. Thus, a stimulating proprioceptive effect on the system of regulation of movements in the system of remodeling of the motor act is realized by stretching the antagonist muscle. This stretching is carried out first by stretching the muscles with an immovable shoulder joint. To do this, use the following technique: the doctor’s hands are superimposed on the two ends of the antagonist muscle at the level of the tendons (the place where the tendons attach to the bones). The places of attachment of muscle tendons to the bones of the shoulder joint are shown in table 2.

Muscle stretching is carried out until a clearly tangible and visible response from the muscle. Stimulation of each muscle in a selected plane is carried out no more than 3-5 times in a row in one procedure. Further, to enhance the normalizing work of the regulatory systems of the central nervous system, a stretching technique with the simultaneous movement of the shoulder joint is used on each antagonist muscle. To do this, passively reproduce the physiological stereotype of movements in which the antagonist muscle is involved, periodically (3-5 times during one movement) stretching this muscle with simultaneous movement of the shoulder joint. In this case, the doctor’s hands are superimposed on the ends of the muscle fibers of the antagonist muscle, without capturing the tendon zone. First, you should choose the muscles to correct the level of rotation in the joint. The next step is the correction of flexion or extension, and only after that is the correction of reduction or abduction.

The results of the treatment of patients with shoulder-shoulder periarthrosis by the method of remodeling of the motor act demonstrate a high clinical effect. Immediately after the procedure, pain syndrome stops at 70-80% of the initial state and mobility is restored in a previously limited direction. This effect increases to 100% in 2-3 days and lasts from 6-7 months. up to 1 year (depending on the social and labor conditions of the patient’s life). Additional treatment methods are not required. However, as it was established on the basis of the clinic, data of electroneuromyography (ENMG), computed tomography (CT), ultrasound (ultrasound), ultrasound dopplerography (Doppler ultrasound) and x-ray examination (Ro), the method is not effective enough (pain syndrome and limitation of mobility are reduced 30–40% of the initial level) when exposed to a nerve that is an innervating muscle, by various physical factors: a hernia or protrusion of the disk, osteophytes, etc.

Clinical examples.

1. Patient K., 24 years old. Diagnosis: osteochondrosis of the cervical spine. Shoulder-shoulder periarthrosis on the right in the acute stage. Complaints of aching pain in the shoulder joint on the right, aggravated by movement and at rest during sleep on the right side. On examination: active movements are painful. Paladatory pain in the projection of the tuberosity of the deltoid muscle and the large tubercle of the humerus. Reflexes and sensitivity in the upper extremities S = D = normal. With active movement in the shoulder joint with weights, a restriction towards internal rotation, flexion and abduction was revealed by the doctor. Based on the data given in table 1, pathological muscles were selected: the large round, the pectoralis major (clavicular part), the deltoid (clavicular and middle parts), the coraco-humeral, the biceps, supraspinatus. Then, based on the data of the same table, antagonist muscles were selected for them: the infraspinatus, the small round, the large round, the deltoid (back), the broadest back, the triceps of the shoulder (long head), the pectoralis major, and the coracorachumera. Since there are identical muscles in the pathological group and in the group of antagonist muscles, the following were excluded from the list of antagonist muscles: the pectoralis major, the large round, and the coracorachumeral. As a result, there were muscles: the infraspinatus, the small round, the deltoid (back), the broadest back and the triceps of the shoulder (long head). Then we worked on the antagonist muscles by stretching at rest for the places of their attachment to the bones of the shoulder joint (ie, their tendons) using the data of Table 2. Then, in order to stimulate the normalizing work of regulatory systems, we stretched the muscles in motion, but already directly behind the muscle fiber.

Immediately after the session, the patient began to actively make movements in the shoulder joint and the pain, in her words, stopped by 80% of the initial one. Upon repeated observation after 3 days, the patient did not observe restrictions on mobility and pain when moving in the right shoulder joint. This effect was observed during the year. Additional physiotherapeutic or medicinal therapeutic measures were not carried out.

Instrumental data before treatment:

1. ENMG - reduction of contractility of the posterior part of the deltoid and pectoralis major muscles (bioactivity level not more than 80-100 μV).

2. Ro - data 4 - signs of periarthrosis (rarefaction of the apex of the large tubercle of the humerus and the acromion of the scapula).

3. UZDG - decrease in blood supply to the extremities (decrease in blood flow through the main vessels to 90% of the norm).

Instrumental data after treatment:

1. ENMG - contractility of the deltoid and pectoralis major muscles within normal limits (bioactivity level of 300 μV).

2. Ro - data - signs of periarthrosis (rarefaction of the apex of the large tubercle of the humerus).

3. UZDG - restoration of speed indicators of blood flow along the main vessels.

2. Patient D., 45 years old. Diagnosis: osteochondrosis of the cervical spine. Cervicalgia. Shoulder-shoulder periarthrosis on the left, a protracted course in the acute stage. Complaints of aching pain in the cervical spine. Pain in the left shoulder joint with passive movements. Active movements are not possible due to pain in the shoulder area (acromial process of the scapula and the outer edge of the scapula). Sick for 6 months. Treated by rubbing and drugs. On examination, contact. Hand on a headscarf. Palpation pain in the projection of the acromial process, the outer edge of the scapula and tuberosity of the deltoid muscle. Active movements due to pain are not possible. Passive movements are painful towards external rotation, flexion and adduction. The movements were carried out with the help of a doctor. Based on the data shown in Table 1, pathological muscles were selected: the sub-muscle, the pectoralis muscle, the pectoralis major muscle (only the clavicular part), the deltoid (clavicular part), the coraco-brachial muscle, the biceps brachii, pectoralis major, round muscle, triceps muscle of the shoulder (long head). Then, based on the data of the same table, antagonist muscles were selected for them: pectoralis major, large round, latitudinal back, deltoid (back), triceps (long head), deltoid (middle part), supraspinatus. Since there are identical muscles in the pathological group and in the group of antagonist muscles, the following were excluded from the list of antagonist muscles: the pectoralis major, the large round, the three-headed shoulders (long head). As a result, the muscles remained: supraspinatus, latissimus dorsi, deltoid (posterior), deltoid (middle). Then we worked on the antagonist muscles by stretching at rest for the places of their attachment to the bones of the shoulder joint (ie, their tendons) using the data of table 2. Then, in order to stimulate the normalizing work of regulatory systems, we stretched the muscles while moving the shoulder joint, but already directly behind the muscle fiber.

Immediately after the session, the patient noted a decrease in pain up to 30-40% of the initial state. The volume of movements increased slightly. The patient noted this effect over the next two days. On the third day, pain arose with the same intensity. The patient underwent computed tomography of C4-C5-C6-C7 cervical discs. Protrusions of C5-C6-C7 discs with intimate adherence to the corresponding roots on the right were revealed. In this regard, a course of massage, phonophoresis of hydrocortisone to the cervical spine and exercise therapy was conducted. Shantz's collar on the cervical spine was shared. At the end of the course, the patient's condition improved: the movements were restored in full, the pain was stopped.

Instrumental data before treatment:

1. ENMG - reduction of contractility of the anterior part of the deltoid and pectoralis major muscles (bioactivity level of 100 μV).

2. Ro - data - signs of periarthrosis (rarefaction of the apex of the large tubercle of the humerus).

3. UZDG - decrease in blood supply to the extremities (decrease in blood flow through the main vessels to 70% of normal).

4. CT - degenerative-dystrophic signs of damage to the cervical spine. Protrusion of C5-C6-C7 discs with intimate adherence to the corresponding roots of the spinal cord of the right side.

Instrumental data after treatment:

1. ENMG - contractility of the deltoid and pectoralis major muscles within normal limits (bioactivity level not more than 300 μV).

2. X-ray data - signs of periarthrosis (rarefaction of the apex of a large tubercle of the humerus).

3. UZDG - restoration of speed indicators of blood flow along the main vessels.

4. CT scan - no change.

Table 1 Function Pathological muscle Antagonist muscle Shoulder rotation inward m. pectoralis major (pectoralis major muscle), m.teres major (pectoralis major muscle). m. infraspinatus, m.teres minor. Shoulder outward rotation m.infraspinatus (infraspinatus muscle), m.teres minor (pectoralis minor muscle). M. pectoralis major, m. Teres major, m. Latissimus dorsi. Shoulder flexion M. pectoralis major (pectoralis major muscle) - only the clavicular part, m.deltoideus (deltoid muscle) - contraction of the anterior (clavicular) part, m.coracobrahialis (coracorachial muscle), m.biceps brachii (biceps brachii) - with reinforced elbow contraction m.triceps. M. teres major, m. Deltoideus (back), m. Latissimus dorsi, m. Teres major, m. Triceps brachii (long head). Shoulder extension m.deltoideus (deltoid muscle) - contraction of the back (scapular) part, m.teres major (large circular muscle), m.triceps brachii (triceps muscle of the shoulder) - long head. m.trapezius (after the horizontal level), m.deltoideus (front part), m.coracobrahialis, m.biceps brachii, m.pectoralis major (clavicular part).

Continuation of table 1 Shoulder abduction m.deltoideus (deltoid muscle) - to the horizontal level - contraction of the middle (acromial) part or the entire muscle, m.supraspinatus (supraspinatus muscle). m.latissimus dorsi, m.pectoralis major, m.teres major, m.coracobrachialis, m.triceps brachii; Cast shoulder M. pectoralis major (pectoralis major muscle), m.teres major (pectoralis major muscle), m.coracobrahialis (coracorachial muscle), m.triceps brachii (triceps brachii) - long head. m.deltoideus (middle part or whole muscle, after a horizontal level), m.supraspinatus.

table 2 Antagonist muscle 1st anatomical attachment point The first point of capture on the RDA system performed by the instructor 2nd anatomical attachment point 2nd capture point according to the RDA system performed by the instructor m.coracobrahialis Processus coracoideus scapulae The coracoid process of the scapula The medial surface of the humerus distally from crista tuberculi minoris The medial surface of the humerus distally from crista tuberculi minoris m.teres minor The outer edge of the scapula The outer edge of the scapula (approximately in the middle or slightly lower) Large tubercle of the humerus Large tubercle of the humerus m.teres major The back surface of the lower angle of the scapula The back surface of the lower angle of the scapula Crista tuberculi minoris humerus Crista tuber-culi minoris humerus

Continuation of table 2 m.pectoralis major The front surface of the sternum and cartilage of the II-VII ribs (pars sterno-costalis) The front surface of the sternum Crista tuberculi majoris humerus At the edge of the deltoid muscle (subclavian fossa) m.pectoralis major (clavicular part) Medial half of the clavicle (pars clavicularis) The medial half of the clavicle. Crista tuberculi majoris humerus At the edge of the deltoid muscle (subclavian fossa) m.biceps brachii Two heads: long - from tuberculum supra-ganglenoidale of the scapula (passes through the cavity of the shoulder joint); short - from processus coracoideus scapulae Processus coracoideusscapulae Tuberositas radii The anterior-ulnar side of the radius, immediately behind the neck (tuberositas radii)

Continuation of table 2 m.triceps brachii (long head) long - from tu-berculum infrag-lenoidale of the scapula (passes between mm.teres major et minor). Shoulder in upper third Olecranon ulna Olecranon ulna m.deltoideus (back) The lateral third of the clavicle and acromion, spina scapulae all over. spina scapulae Tuberositas deltoidea in the middle of the humerus. Tuberositas deltoidea in the middle of the humerus. m.deltoideus (front) The lateral third of the clavicle and acromion, spina scapulae all over. The lateral third of the clavicle and acromion. Tuberositas deltoidea in the middle of the humerus. Tuberositas deltoidea in the middle of the humerus. m.deltoideus (middle part) The lateral third of the clavicle and acromion, spina scapulae all over. lateral third of the clavicle and acromion, spina scapulae. Tuberositas deltoidea in the middle of the humerus. Tuberositas deltoidea in the middle of the humerus.

Continuation of table 2 m.trapezius The spinous processes of all the thoracic vertebrae, the upper dividing line (lin. Nuchae superior) of the occipital bone. Upper dividing line (lin. Nuchae superior) of the occipital bone. Acromial end of the clavicle. Acromial end of the clavicle. m.latissimu s dorsi The spinous processes of the lower four thoracic (sometimes five to six), all lumbar and sacral vertebrae, the posterior part of the iliac crest, with four teeth from the four lower ribs. The spinous processes of the lower four thoracic (sometimes five to six), all lumbar and sacral vertebrae, the posterior part of the iliac crest, with four teeth from the four lower ribs. Crista tuberculi minoris humerus Crista tuberculi minoris of the humerus (anterior to the large tubercle and tendon of the long biceps head).

Continuation of table 2 m. infraspinatus Scapula under spina scapulae (fossa infraspinata). The shoulder blade under the crest of the shoulder blade. Large tubercle of the humerus. Large tubercle of the humerus. m.supraspinatus Scapula over spina scapulae (fossa supraspinata). The shoulder blade over the crest of the shoulder blade. Large tubercle of the humerus. Large tubercle of the humerus.

Claims (1)

A method for the treatment of brachiocephalic periarthritis, including exposure in the acute period to the area of the shoulder joint and involving the latissimus dorsi, flexors of the forearm, extensors of the shoulder, supraspinatus, coraco-humeral, supraspinatus and deltoid muscles of the shoulder, lifting the arm to the side, then lowering the arm down and raising the straight arm as high as possible, lowering the hand down and rotation, characterized in that the direction of limiting its mobility is determined in all planes of movement of the shoulder joint azimized, painful muscles, antagonist muscles are chosen for spasmodic muscles, antagonist muscles are stretched in statics by the points of attachment to the bones along the fiber, alternately for each muscle in the following sequence: rotation, flexion-extension, abduction-reduction in all planes of movement of the shoulder joint, repeat the stretching of the antagonist muscles 3-5 times per procedure, after which the muscle fiber of each muscle is stretched in movement in the directions opposite to the directions in which the “pain syndrome” is felt Alternately in the following sequence: rotation, flexion-extension, abduction-adduction in all planes of motion of the shoulder joint of 3-5 for the procedure.