LME - Terminologia LME Lesões Músculo-Esqueléticas LMERT Lesões Músculo-Esqueléticas relacionadas com o Trabalho PME Perturbações Músculo-Esqueléticas TMS Troubles Musculo-squélétiques squélétiques CTD Cumulative Trauma Disorder WRSMD Work related skeletal muscle disorders RSI Repetitive Strain Injuries DORT Doenças Ósteo-articulares relacionadas com o Trabalho
A importância das LME na União Europeia 33% dos trabalhadores europeus têm queixas do ombro Cerca de 23 % dessas são de origem músculo- tendinosa Cerca de 28 % dos trabalhadores europeus têm stresse Em França, as LME representam 63% das D. Profissionais 39% dos trab. portugueses sofrem de dores das costas 31% dos trab. portugueses têm queixas dos membros Superiores Na Holanda, as LME representam custos de 687 milhões de dólares (0,1% do PNB ) e na GB, cerca de 1,2 biliões de Libras
O OMBRO
3 Estruturas Ósseas Anatomia Funcional Clavicula Escapula Úmero
6 Articulações Coraco-ClavicularClavicular Esterno-Clavicular Acromio-Clavicular Gleno-Humeral Escápulo-Thoracic Espaço Sub-Acromial
Coraco-ClavicularClavicular
Esterno-Clavicular
Acromio-Clavicular
Gleno-Humeral
Escápulo-Torácica
Sub-Acromial
Cintura escapular Revisão Anatomica
Revisão Anatomica Anatomia Óssea Escápula Clavicula
Revisão Anatomica Anatomia óssea Ùmero Costelas
Muscúlos 15 músculos movimentam e estabilizam a escápula 9 músculos originam o movimento da gleno-umeral 6 suportam a escápula no torax
O entrelaçamento muscular e a falta de estruturas ósseas ou ligamentosas restritivas permitem movimentos de enorme complexidade e intervalo de amplitude. Os movimentos produzidos combinam força, orientação e precisão
Em contrapartida o ombro é muito vulnerável a sobrecargas ou forças exteriores
Revisão Anatómica Músculos: Coifa dos Rotadores: Supraespinhoso, Infraespinhoso Pequeno Redondo, Subescapular (?) (SIPS)
Revisão Anatómica Coifa dos Rotadores:
Revisão Anatómica Músculos: Escapulares: Romboides (grande e pequeno), Pequeno Peitoral Trapézio, Levantador da Escápula, Dentado Anterior
Revisão Anatómica
Revisão Anatómica Músculos: Umerais: Grande Dorsal Tricipete, Grande Peitoral, Bicípete, Deltoide, Coracobraquial, Grande Redondo
Revisão Anatómica
Revisão Anatomica Musculatura anterior
Revisão Anatomica Musculatura Posterior
Revisão Anatomica Ligamentos: Acromio-clavicular, clavicular, Coraco-clavicular clavicular (trapezoide e conoide), Transverso, Esterno-clavicular, Coroco-acromial, Costo-clavicular
Revisão Anatomica Ligamentos do Ombro
Revisão Anatomica Bolsas Sinoviais: Sub-acromial Sub-deltoideia
Revisão Anatomica Cápsula e Cartilagem Articulares
Revisão Anatomica Plexo Braquial
O Exame do Ombro
Evaluation Principles Always follow a standard progression Determine the target tissue What area is injured Get a History is this a new injury, old chronic injury Assessment Correlate signs, symptoms, biomechanical info
Assessment what is the primary problem? Plan Treatment Referral Short and Long Term Goals Follow up
Always follow the same plan Evaluation Order History Observation Palpation Stress
BONY PALPATION Anterior
sternoclavicular joint
clavicular shaft
acromioclavicular joint
coracoid process
acromion process
head of humerus
greater tuberosity
lesser tuberosity
bicipital groove
BONY PALPATION Posterior
spine of scapula
vertebral border of scapula
lateral border of scapula
superior angle
inferior angle
SOFT TISSUE PALPATION Anterior
sternoclavicular ligament
acromioclavicular ligament
coracoclavicular ligament
anterior deltoid
middle deltoid
subacromial bursa
pectoralis major muscle
sternocleidomastoid muscle
biceps muscle and tendon
coracoacromial ligament
glenohumeral joint capsule
SOFT TISSUE PALPATION Posterior
posterior deltoid
rhomboids
latissimus dorsi
serratus anterior
levator scapula
trapezius
supraspinatus
infraspinatus
teres minor
teres major
SOFT TISSUE PALPATION Others
axilla
lymph nodes
Movements Flexion 90 degrees Primary Flexors Anterior Deltoid Coracobrachialis Pectoralis Major Biceps
Movements Extension Primary Extensors Latissimus dorsi Teres Major Teres Minor Triceps
Abduction Primary Abductors Supraspinatus Mid Deltoid Serratus Anterior Infraspinatus
Adduction Primary Adductors Anterior Deltoid Pectoralis Major Subscapularis
External Rotation Primary External Rotators Posterior Deltoid Infraspinatus Teres Minor
Internal Rotation Primary Internal Rotators Subscapularis Pectoralis Major Latissimus Dorsi Teres Major Anterior Deltoid
The body limits internal rotation - thus placing the arm behind the body increases the amount of internal rotation Internal Rotation
SPECIAL TESTS Glenohumeral instability
Apprehension test Pain Feeling of Apprehension about the shoulder potentially re subluxating or dislocating
Relocation (Jobe or Fowler) test
Anterior Drawer test; Posterior Drawer test; Inferior Drawer (Feagin) test
Sulcus sign
Clunk test
SPECIAL TESTS Acromioclavicular
Shear (Compression) test
Piano Key sign
SPECIAL TESTS Rotator Cuff
Drop Arm test
Empty Can test Specific for trauma to the Supraspinatus muscle tendon irritation impingement and or tear
SPECIAL TESTS SLAP
O Brien s Test
SPECIAL TESTS Impingement tests
Active Impingement test
Neer Impingement test
Hawkins-Kennedy test Hawkins-Kennedy Impingement Sign: passive internal rotation at 90 shoulder flexion, elbow at 90
Drop-Arm test Pain Dropping of Arm Supraspinatus Tendon
SPECIAL TESTS Biceps Tendon
Speed s test Pain Weakness Long Head of Biceps Tendon
Ludington s test
Yergason s test Yergason s: Stability of tendon of long head of biceps in bicipital groove pain Popping Transverse Humeral Ligament Long Head of the Biceps irritation
SPECIAL TESTS Thoracic Outlet Syndrome
Adson s test Adson s: loss of radial pulse (compression of subclavian artery) Caused by ant. scalene muscle & pec. minor Head looks towards abducted (30 ) externally rotated shoulder, & elbow extended w/ thumb pointing up; deep breath Thoracic Outlet Syndrome
Allen s test Allen Test: loss of radial pulse (compression of neurovascular bundle) Caused by the pectoralis minor muscle Head looks away while elbow is flexed (90 ) & shoulder abducted (90 ); shoulder passively horiz. abducted & ext. rotated Thoracic Outlet Syndrome
Military Brace position Military Brace Position loss of radial pulse (compression of subclavian artery by costoclavicular structures of shoulder) Humerus extended & abducted 30 while neck & head are hyperextended
Roos test
SPECIAL TESTS Others
Pectoralis Major Contracture test
Apley s scratch test