Quadrilateral space syndromeに広背筋部痛を合併した投球障害肩の一症例
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- あきみ やすもと
- 7 years ago
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1 ) ) ) ) (MD) 1) 2)
2 winging one point early cocking phase follow through phase winging MMT SSP testspeed testimpingement sign winging 7 26 MMT winging scapula winging winging
3
4
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6 (MD) (MD) (MD) 2 (MD) key words 30 Gustilo A debridement debridement PT PT 12 AK ROM 2 ROM toe touch 28 FWB AK PT ROM SLR -3cm PT ROM lag PT 0 70 ROM ROM
7 (MD) (MD) (MD) key words (MD) AO typec2 ROM, cm 54kg H debridement 6kg 9.21 (stability alignment ) knee brace (NWB) /4PWB 12 PT H PT 30 0Lag40-50Quad.Ham.2 ENT 110 0Lag10Quad.Ham.5- ENT 130 0Lag0Quad.Ham.4 PF ROM Lateral release Suprapatella pouchlateral&medial gutter PatellaSettingPatella ( ) C ROM ROM90 PT ROM ROM
8 1 1) (MD)2 1) 2 3) ( PT) open book 3 4 screw 4 19 PT 3 22 PT ROM 5 17 FWB 1/3PWB PT ROM 0 MMT 23 Thomas test() over test() () 15 ROM 10 Thomas test()over test() Bed PT
9 , OA., (AO A1). 60,. 150, 65. :H :H15. ( ). : H MIPPO DCS. Kneebrace ROM.10.27Kneebraceoff /4PWB ,, H :patella,,. : 9~10cm. :,SLR.VAS/10.ROM-t MMT: ( 2 )Knee brace off ROMex H :. : 1~3. :,patella.vas1/10.rom: 125-5MMT: 4.lag0 : T, ROM..ROM ORIF, ROM OA,.,,.
10 TTS MD TTS tarsal tunnel syndrome TTS Lauge-Hansen SER Stage TTS amplitude TTS TTS mortise TTS ADL
11 LaugeHansen SER stage off1/2pwb BK 5 ROM MMT 3 ROM- / active 5/20 5/25 35/60passive 10/25 10/30 40/65 1/
12 MD MD MD KEY WORDS,,,. 60 : X-, 2 Rüedi2 pilon.. : , K-wire, J-plate screw,alignment good,stability acceptable, PTB.7 5 X.7 13, /4PWB,8 9 1/2PWB,10 4 FWB , H VAS4/10.,,..ROM-T MMT 3+, 3, 3,4. footprint knee-in toe-out,,.,,..,mortise,.,,,.,,.,,.4,,.,,,,.,, 10~20 PTB,,.
13 2 ¹) ) ) Zuggurutung tension band wiring tension band wiring tension band wiring infrapatellar tissue
14 tightness 1) 1) 1) 2) 1) 2) Hip-spine syndrome MacNab Offierski 1983 muscle tightness 4 H16.7H Thomas test ()Ober test () SLR505 2 ( 2 ) 2 ( 1 1 ) iliopsoastflhamstrings Thomas test()1 ()3 Ober test()3 ()1 SLR70 4 muscle tightness tightness tightness iliopsoastfl mechanical stress Hamstrings hyper mobile iliopsoastfl tightness Hip-spine syndrome
15 1) 1) 1) 2) 2) 1) 2) m Rt.-20 Lt.-30 Rt.5 Lt.5 Thomas test Ober test spasm 3 800m 8 1km X-p JOA score 19 2
16 MD hypomobility L4/L X L5/S1 hypomobility MRI L4/L5 protrusion type SLR test Kemp test Friberg test Patrick test L5/S1 L5/S1 L5/S1
17
18 AO B 27 3 OT ROM cm 36cm 29cm 10cm 31cm 28cmMP ROMex 10 functional brace ROM 15 ROM X-P ROM OT 3 OT ex X-P functional brace ROMex
19 KEY WORDS ORIF,.,, ,. pinnig., Lowman,5.5 6 off, , 60, 60, 30, 40, 5, 10.,, ActiveROM,,., 15, 75, 35, 40, 30, 20.MMT kg.,, 3.,, shortning,radial tilt TFCC.,,, RCL,RSC,RSL., grip,.,.,.,.,,,.
20 KEY WORDS Compartment Compartment Compartment Compartment / Anterior:9/77mmHg Posterior:11/55mmHgLateral:10/43mmHg 30mmHg Anterior Posterior Compartment 20cm Anterior Lateral superficial Posterior Deep Posterior Compartment H ROMex /2PWB FWB 30mmHg 20 5
21 MCL MCL Dynamic alignment Knee in Toe out KITO stretching stretching MCL MCL MCL MCL MCL MCL MCL MCL Dynamic alignment KITO MCL KITO Dynamic alignment MCL
22
23 Pilon Pilon cm wiping ex. wipping ex excursion
24 MD MD PT 50 platescrew screw PT
25 MP MP cm MP 5 3 active ROM 21 4 passive ROM 3 3 ampulitude 4 excursion 6 stretch MP ampulitude IP MP 6 MP 3 MP MP ampulitude MP MP
26 X M1M2 M1M
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-1- -2- -4- -5- 20 30 12-6- 8 15 1-7- -8- -9- -10- 40 60-11- -12- 3 4 70 90-13- -14- 2 4 3 5-15- a 3-16- -17- -18- 128 kg 150 200g 100 200g 250 750g 2 1 94 89 89 81 72 390 97 97 83 83 75 97 97 100 86