Discinesia escapular visual: alterações na cinemática da escápula e atividade muscular em pacientes com síndrome do impacto
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Data
2013-11-27
Autores
Lopes, Andréa Diniz [UNIFESP]
Orientadores
Ciconelli, Rozana Mesquita [UNIFESP]
Tipo
Tese de doutorado
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Objetivos: Determinar a cinemática e atividade muscular escapular em pacientes com Síndrome do Impacto (SI) com e sem discinesia escapular visualmente identificada através do Teste da Discinesia Escapular (TDE). Métodos: Estudo observacional transversal realizado na Virginia Commonwealth University no período de Julho a Dezembro de 2011. O estudo foi aprovado pelo comitê de ética em pesquisa local e da Universidade Federal de São Paulo. Trinta e oito participantes com diagnóstido de SI foram incluídos no estudo. O movimento escapular foi
classificado visualmente através do TDE como discinesia escapular óbvia (DISC, n = 19) ou sem discinesia escapular (NÃO DISC, n = 19). O estado de saúde foi medido através dos questionários Penn Shoulder Score (PSS) e Western Ontario Rotator Cuff Index (WORC). Um sistema de captura de movimento eletromagnético foi utilizado para avaliar a cinemática tridimensional do tórax, úmero e escápula e eletromiografia de superfície (sEMG) para medir a atividade muscular do trapézio superior, médio e inferior, serrátil anterior e infra-espinal durante 5 repetições consecutivas de flexão do ombro bilateral, ativa, resistida nas fases de subida e descida. As diferenças entre os grupos nas pontuações do PSS e WORC foram testadas através do teste-t. Modelos mistos ANOVAs foram utilizados para testar o fator grupo e o fator repetido em 4 ângulos de elevação do braço (30°, 60°, 90° e 120°) para cinemática e 3 intervalos de elevação (30°-60°, 60°-90° e 90°-120°) para sEMG. Resultados: O grupo DISC relatou piora do estado de saúde através da redução de 9,1 pontos e 13,7 pontos (0-100 pontos) nos questionários PSS e WORC, respectivamente, diminuição da rotação lateral da escápula de 2,1° e 2,5° durante as fases de subida e descida, respectivamente, e aumento da atividade muscular de 12% da contração isométrica voluntária maxima (CIVM) do trapézio superior durante a subida no intervalo de 30°-60° de flexão do ombro. Conclusões: Pacientes com SI e discinesia escapular óbvia identificada visualmente apresentaram alterações na rotação lateral da escápula e na atividade do músculo trapézio superior. Esses déficits podem, em parte, contribuir para a redução da função do ombro e da qualidade de vida relacionada à saúde. Estudos futuros deverão determinar se a correção desses déficits aboliria a discinesia escapular e melhoraria o estado de saúde relatado pelos pacientes.
Objectives: Determine scapular kinematics and muscle activity in patients with impingement syndrome with and without visually identified scapular dyskinesis by the Scapular Dyskinesis Test (SDT). Methods: Cross-sectional observational study conducted at Virginia Commonwealth University from July to December of 2011. The study was approved by the local and Universidade Federal de Sao Paulo Institutional Review Boards for the protection of human subjects. Thirty-eight participants with impingement syndrome diagnosis were included in the study. The participants scapular motion were visually classified by the SDT as obvious scapular dyskinesis (DYSK;n=19) or no scapular dyskinesis (NO-DYSK;n=19). The health status was measured with the Pennsylvania Shoulder Score (PSS) and Western Ontario Rotator Cuff Index (WORC) questionnaires. An electromagnetic motion analysis system was used to capture three-dimensional kinematics of the thorax, humerus and scapula. Simultaneously, surface electromyography (sEMG) was used to measure muscle activity of upper, middle and lower trapezius, serratus anterior and infraspinatus during ascending and descending phases of bilateral, active, weighted shoulder flexion. T-test was used to compare PSS and WORC scores. Mixed model ANOVAs were used to test the group-factor and repeated-factor of 4 arm elevation angles (30°, 60°, 90° e 120°) for kinematics and 3 arm elevation intervals (30°-60°, 60°-90° e 90°-120°) for sEMG. Results: The DYSK group reported 9.1 points and 13.7 points (0-100 points) lower health status by the PSS and WORC, respectively, exhibited less scapular external rotation of 2.1° and 2.5° during the ascending and descending phases, respectively and 12% of maximum voluntary isometric contraction (MVIC) higher upper trapezius sEMG muscle activity during ascent in the 30°-60° interval of shoulder flexion. Conclusions: Patients with impingement syndrome and visual obvious scapular dyskinesis had altered scapular external rotation and upper trapezius muscle activity. These deficits may in part contribute to the reduced shoulder function and heath-related quality of life. Future studies should determine if correction of these deficits would abolish scapular dyskinesis and improve patientrated outcomes.
Objectives: Determine scapular kinematics and muscle activity in patients with impingement syndrome with and without visually identified scapular dyskinesis by the Scapular Dyskinesis Test (SDT). Methods: Cross-sectional observational study conducted at Virginia Commonwealth University from July to December of 2011. The study was approved by the local and Universidade Federal de Sao Paulo Institutional Review Boards for the protection of human subjects. Thirty-eight participants with impingement syndrome diagnosis were included in the study. The participants scapular motion were visually classified by the SDT as obvious scapular dyskinesis (DYSK;n=19) or no scapular dyskinesis (NO-DYSK;n=19). The health status was measured with the Pennsylvania Shoulder Score (PSS) and Western Ontario Rotator Cuff Index (WORC) questionnaires. An electromagnetic motion analysis system was used to capture three-dimensional kinematics of the thorax, humerus and scapula. Simultaneously, surface electromyography (sEMG) was used to measure muscle activity of upper, middle and lower trapezius, serratus anterior and infraspinatus during ascending and descending phases of bilateral, active, weighted shoulder flexion. T-test was used to compare PSS and WORC scores. Mixed model ANOVAs were used to test the group-factor and repeated-factor of 4 arm elevation angles (30°, 60°, 90° e 120°) for kinematics and 3 arm elevation intervals (30°-60°, 60°-90° e 90°-120°) for sEMG. Results: The DYSK group reported 9.1 points and 13.7 points (0-100 points) lower health status by the PSS and WORC, respectively, exhibited less scapular external rotation of 2.1° and 2.5° during the ascending and descending phases, respectively and 12% of maximum voluntary isometric contraction (MVIC) higher upper trapezius sEMG muscle activity during ascent in the 30°-60° interval of shoulder flexion. Conclusions: Patients with impingement syndrome and visual obvious scapular dyskinesis had altered scapular external rotation and upper trapezius muscle activity. These deficits may in part contribute to the reduced shoulder function and heath-related quality of life. Future studies should determine if correction of these deficits would abolish scapular dyskinesis and improve patientrated outcomes.
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Citação
LOPES, Andréa Diniz. Discinesia escapular visual: alterações na cinemática da escápula e atividade muscular em pacientes com síndrome do impacto. São Paulo, 2013. 104 f. Tese (Doutorado em Medicina Translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2013.