Hombros con inestabilidad glenohumeral anterior. Alteraciones musculares.

Alteraciones de la activación del músculo reflexivo en hombros con inestabilidad glenohumeral anterior.

Joseph B. Myers, PhD, ATC*,, Yan-Ying Ju, PhD, PT, ATC, Ji-Hye Hwang, MD, PhD, Patrick J. McMahon, MD, Mark W. Rodosky, MD and Scott M. Lephart, PhD, ATC
From the University of Pittsburgh, Pittsburgh, Pennsylvania, Chang Gung University, Taoyuan, Taiwan, and the Samsung Medical Center, Sungkyunkwan University, Seoul, Korea

Background: Patients with glenohumeral instability have proprioceptive deficits that are suggested to contribute to muscle activation alterations.

Hypothesis: Muscle activation alterations will be present in shoulders with anterior glenohumeral instability.

Study Design: Posttest-only control group design.

Methods: Eleven patients diagnosed with anterior glenohumeral instability were matched with 11 control subjects. Each subject received an external humeral rotation apprehension perturbation while reflexive muscle activation characteristics were measured with indwelling electromyography and surface electromyography.

Results: Patients with instability demonstrated suppressed pectoralis major and biceps brachii mean activation; increased peak activation of the subscapularis, supraspinatus, and infraspinatus; and a significantly slower biceps brachii reflex latency. Supraspinatus-subscapularis coactivation was significantly suppressed in the patients with instability as well.

Conclusions and Clinical Relevance: In addition to the capsuloligamentous deficiency and proprioceptive deficits present in anterior glenohumeral instability, muscle activation alterations are also present. The suppressed rotator cuff coactivation, slower biceps brachii activation, and decreased pectoralis major and biceps brachii mean activation may contribute to the recurrent instability episodes seen in this patient group. Clinicians can implement therapeutic exercises that address the suppressed muscles in patients opting for conservative management or rehabilitation before and after capsulorraphy procedures.

The American Journal of Sports Medicine 32:1013-1021 (2004)