ARTROSKOPİK ROTATOR KILIF TAMİRİ YAPILAN HASTALARDA TEK SEANS PERTURBASYON EGZERSİZİNİN OMUZ AKTİF EKLEM POZİSYON HİSSİ VE TRAPEZİUS KAS AKTİVASYONU ÜZERİNE ETKİSİ

Yıl 2022, Cilt: 3 Sayı: 2, 56 - 61, 31.08.2022

İrem Düzgün Özgül Kiremit Zekiye Nisa Özberk Bülent Elbasan Ahmet Özgür Atay

https://doi.org/10.52831/kjhs.1063292

Öz

Amaç: Rehabilitasyonun ileri aşamalarında yapılan perturbasyon egzersizleri nöromuskuler kontrolü artırır. Bu çalışmanın amacı 6 ay önce artroskopik rotator kılıf tamiri yapılan hastalarda tek seans uygulanan perturbasyon egzersizinin aktif eklem pozisyon hissi ve trapezius kasının elektromiyografik aktivasyonu üzerine erken etkisini incelemektir.
Yöntem: Artroskopik rotator kılıf tamiri yapılan 12 kişi çalışma grubu olarak (yaş: 54.83±3.5), asemptomatik omuz eklemi olan 13 kişi kontrol grubu olarak (yaş: 49.07±4.5) çalışmaya dahil edildi. Tüm katılımcılar, tek seanslık pertürbasyon egzersizinden önce ve sonra değerlendirildi. 90° omuz fleksiyonunda ve abdüksiyonda aktif eklem pozisyonu hissi, lazer imleç yardımlı açı tekrarlama testi kullanılarak değerlendirildi. Bu test sırasında trapezius kaslarının aktivasyonu yüzeyel elektromiyografi cihazıyla kaydedildi. Egzersiz öncesi ve sonrası değerler grup içi Wilcoxon signed rank testi, grup karşılaştırmaları Mann-Whitney U testi kullanılarak analiz edildi.
Bulgular: Pertürbasyon egzersizi öncesi ve sonrası aktif açı tekrarlama testinde gruplar arasında fark yok idi (fleksiyon p:0.124; abduksiyon p:0.421). Egzersiz sonrası elektromiyografi aktivasyonları karşılaştırıldığında, cerrahi yapılan taraf üst trapez ve diğer taraf alt trapez aktivasyonu azaldı (p:0.01). Trapezius kasının elektromiyografi aktivasyonu ile aktif eklem pozisyon hissi arasında korelasyon yoktu (fleksiyon p:0.657; abduksiyon p:0.662).
Sonuç: Rotator kılıf tamiri sonrası altıncı ayda tek seans pertürbasyon egzersizlerinin aktif eklem pozisyon hissi üzerine erken etkisinin olmadığı görüldü.

Anahtar Kelimeler

Elektromyografi, Perturbasyon, Propriosepsiyon, Rotator Kılıf Yaralanmaları

THE EFFECT OF SINGLE-STAGE PERTURBATION EXERCISE ON THE SHOULDER JOINT POSITION SENSE AND TRAPEZIUS MUSCLE ACTIVATION IN PATIENTS WITH ARTHROSCOPIC ROTATOR CUFF REPAIR

Öz

Objective: Perturbation exercises conducted on mobile surfaces in the latter period of the rehabilitation increase the neuromuscular control. The purpose of the study was to investigate the effects of single session perturbation exercises’ on active joint position sense and on the electromyography activation of the trapezius muscle in patients who underwent arthroscopic rotator cuff repair in the previous 6 months.
Method: 12 individuals who underwent arthroscopic rotator cuff repair were included in the study as the study group (age: 54.83±3.5), and 13 individuals with in an asymptomatic shoulder joint were included as the control group (age: 49.07±4.5). All subjects were evaluated before and after single-session perturbation exercise. Active joint position sense at 90° shoulder flexion and abduction was assessed using a laser pointer-assisted angle reproduction test. The activation of the trapezius muscles during this test was recorded by the superficial electromyography tool. The pre-exercise and post-exercise values were analyzed using an in-group Wilcoxon signed-rank test. The Mann–Whitney U test was used for group comparisons.
Results: There was no difference between groups in the active angle reproduction test before and after the perturbation exercise (flexion p:0.124; abduction p:0.421). When electromyography activations after the exercise were compared, the activation of the operated upper trapezius (p:0.01) and the non-operated lower trapezius decreased (p:0.024). There was no correlation between the electromyography activation of the trapezius muscle and active joint position sense (flexion p:0.657; abduction p:0.662).

Anahtar Kelimeler

Electromyography, Perturbation, Proprioception, Rotator Cuff Injuries

Kaynakça

• Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am. 2012;94(3):227-233.
• McCormick F, Wilcox RB, Alqueza A. Postoperative Rotator Cuff Repair Rehabilitation and Complication Management. Oper Tech Orthop. 2015;25(1):76-82.
• Tsuda Y, Amako M, Takashima K, Kawaguchi M. Preoperative and postoperative shoulder position sense in patients who underwent arthroscopic Bankart repair for traumatic shoulder joint instability. JSES Int. 2021;5(2):190-193.
• Amanda LA, Dorien B, Lode D, et al. Proprioception: How is it affected by shoulder pain? A systematic review. Journal of Hand Therapy. 2020; 33(4):507-516.
• De Castro Pochini A, Ejnisman B, de Seixas Alves MT, et al. Overuse of training increases mechanoreceptors in supraspinatus tendon of rats SHR. J Orthop Res. 2011;29(11):1771-1774.
• Duzgun I, Turhan E. Proprioception after shoulder injury, surgery and rehabilitation. In: Kaya D, Yosmaoğlu B, Doral MN eds. Proprioception in orthopaedics, sports medicine and rehabilitation. Springer, Cham; 2018:35-45.
• Maenhout AG, Palmans T, De Muynck M, De Wilde LF, Cools AM. The impact of rotator cuff tendinopathy on proprioception, measuring force sensation. J Shoulder Elbow Surg. 2012;21:1080-1086.
• Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. Int Orthop. 2018;43(8):229-235.
• Yang JL, Jan MH, Hung CJ, Yang PL, Lin JJ. Reduced scapular muscle control and impaired shoulder joint position sense in subjects with chronic shoulder stiffness. J Electromyogr Kinesiol. 2010;20(2):206-211.
• Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology. Arch Phys Med Rehab. 2011;92:1146-1151.
• Clark NC, Roijezon U, Treleaven J. Proprioception in musculoskeletal rehabilitation. Part 2: Clinical assessment and intervention. Man Ther. 2015;20:378-87.
• Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilita-tion. Man Ther. 2011;16:33-39.
• Pollock CL, Ivanova TD, Hunt MA, Garland SJ. Motor unit recruitment and firing rate in medial gastrocnemius muscles during external perturbations in standing in humans. J Neurophysiol. 2014;112:1678-1684.
• Balke M, Liem D, Dedy N. The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability. Arch Orthop Trauma Surg. 2011;131:1077-1084.
• Cid MM, Januario LB, Zanca GG, Mattiello SM, Oliveira AB. Normalization of the trapezius sEMG signal - a reliability study on women with and without neck-shoulder pain. Braz J Phys Ther. 2018;22(2):110-119.
• Huang H, Lin J, Guo YL, Wang WT, Chen Y. EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement. J Electromyogr Kinesiol. 2013;23(1):267-274.
• De Fontenay BP, Mercier C, Bouyer L, Savoie A, Roy JS. Upperlimb active joint repositioning during a multi joint task in participants with and without rotator cuff tendinopathy and effect of a rehabilitation program. J Hand Ther. 2020;33(1):73-79.
• Tsuda Y, Amako M, Takashima K, Kawaguchi M. Preoperative and postoperative shoulder position sense in patients who underwent arthroscopic Bankart repair for traumatic shoulder joint instability. JSES Int. 2021;5(2):190-193.
• Lee SJ, Ren Y, Chang AH, Geiger F, Zhang L. Effects of pivoting neuromuscular training on pivoting control and proprioception. Med Sci Sports Exerc. 2014;46(7):1400-1409.
• Arundle AJH, Cummer K, Capin JJ, Zarzycki R, Snyder-Mackler L. Report of the clinical and functional primary outcomes in men of the ACL_SPORT trial: Similar outcomes in men receiving secondary prevention with and without perturbation training 1 and 2 years after ACL reconstruction. Clin Orthop Relat Res. 2017;475(10):2523-2534.
• Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskelet Disord. 2020;21(1):647.
• Moutzouri M, Gleeson N, Billis E, Panoutsopoulou I, Gliatis J. What is the effect of sensori-motor training on functional outcome and balance performance of patients’ undergoing TKR? A systematic review. Physiother. 2016;102(2):136-144.
• Oliveira AS, Carvalho M, de Brum DPC. Activation of the shoulder and arm muscles during axial load exercises on a stable base of support and on a medicine ball. J Electromyogr Kinesiol. 2008;18:472-479.
• Yang F, Pai CY. Alteration in community-dwelling older adults' level walking following perturbation training. J Biomech. 2013;46:2463-2468.
• Struyf F, Cagnie B, Cools A, et al. Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol. 2014;24(2):277-284.
• Shinozaki N, Sano H, Omi R, et al. Differences in muscle activities during shoulder elevation in patients with symptomatic and asymptomatic rotator cuff tears: analysis by positron emission tomography. J Shoulder Elbow Surg. 2014;23:61-67.
• Cools AM, Dewitte V, Lanszweert F. Rehabilitation of scapular muscle balance: which exercises to prescribe? Am J Sports Med. 2007;35:1744-1751.
• Pirauá ALT, Pitangui ACR, Silva JP, et al. Electromyographic analysis of the serratus anterior and trapezius muscles during push-ups on stable and unstable bases in subjects with scapular dyskinesis. J Electromyogr Kinesiol. 2014;24:675-681.
• Seo SH, Jeon IH, Cho YH, Lee HG, Hwang YT, Jang JH. Surface EMG during the push-up plus exercise on a stable support or swiss ball: scapular stabilizer muscle exercise. J Phys Ther Sci. 2013;25:833-837.
• Stackhouse SK, Sweitzer BA, McClure PW: The effect of experimental shoulder pain on contralateral muscle force and activation. Physiother Theory Pract. 2019;1-8.