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POGOSTE POŠKODBE RAMENA, KI NASTANEJO PRI TRENINGU IN IGRANJU ROKOMETA (COMMON SHOULDER INJURIES IN HANDBALL)
Abstract
Overhead sports such as handball place significant stress on the soulder joint and
surrounding structures and put the athlete at considerable risk of injuries. Repeated
overhead activities place high mechanical loads and are done frequently and intensively and as such have the potential to injure involved tissues. Athletic injuries to the shoulder most commonly involve the rotator cuff, glenohumeral joint and acromioclavicular joint. The agile character of the handball game is associated with a number unexpected stuations, external disturbances of movement and the extreme positions of bofy segments which can be a cause for a lot of injuries in handball. Regardless of the injury prevention program, there will always be injuries in sports.
Successful shoulder rehabilitation depends on the understanding of the functional anatomy and biomechanics of the shoulder, the cause of injury and a complete and accurate diagnosis of the involved tissues. Therefore, a thorough understanding of the physical demands of the activity is a prerequisite to making a complete diagnosis and returning the athlete to a safe, pain-free participation.
The thesis first describes the structure and the physical strain of the handball game. It
focuses on the changes in posture of athletes and describes the most common shoulder
injuries in handball. Also the clinical testing is presented as a tool to help determine which
tissues are injured. Finally, the thesis presents a shoulder rehabilitation programme and an effective example of shoulder exercises which can be efficiently incorporated into handball training. Those exercises can reduce the risk of a shoulder injury.
ResearchGate has not been able to resolve any citations for this publication.
Aim:
To determine whether rotator cuff strength, glenohumeral joint range of motion and scapular control are associated with shoulder injuries among elite male handball players.
Methods:
A total of 206 players in the Norwegian elite handball league for men were tested prior to the 2011-2012 season. Measures included: (1) glenohumeral internal and external rotation range of motion, (2) isometric internal rotation, external rotation and abduction strength and (3) assessment of scapular dyskinesis. Players were followed prospectively for the entire regular season (30 weeks), with shoulder problems registered bi-weekly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A cumulative severity score was calculated for each player based on their questionnaire responses. This was used as the outcome measure in risk factor analyses.
Results:
The average prevalence of shoulder problems throughout the season was 28% (95% CI 25% to 31%). The prevalence of substantial shoulder problems, defined as those leading to moderate or severe reductions in handball participation or performance, or to time loss, was 12% (95% CI 11% to 13%). Significant associations were found between obvious scapular dyskinesis (OR 8.41, 95% CI 1.47 to 48.1, p<0.05), total rotational motion (OR 0.77 per 5° change, 95% CI 0.56 to 0.995, p<0.05) and external rotation strength (OR 0.71 per 10 Nm change, 95% CI 0.44 to 0.99, p<0.05) and shoulder injury.
Conclusions:
Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control.
The overhead throwing athlete is an extremely challenging patient in sports medicine. The repetitive microtraumatic stresses imposed on the athlete's shoulder joint complex during the throwing motion constantly place the athlete at risk for injury. Treatment of the overhead athlete requires the understanding of several principles based on the unique physical characteristics of the overhead athlete and the demands endured during the act of throwing. These principles are described and incorporated in a multiphase progressive rehabilitation program designed to prevent injuries and rehabilitate the injured athlete, both nonoperatively and postoperatively.
The overhead-throwing athlete is a challenging sports medicine patient. The repetitive microtraumatic stresses imposed on the athlete's shoulder joint complex during the throwing motion constantly places the athlete at risk for injury. These stresses may effect several adaptations to normal shoulder range of motion, strength, and scapula position. The clinician should therefore appreciate the unique physical characteristics of the overhead-throwing athlete to accurately evaluate and treat throwing-related injuries.
Unlabelled:
This is a retrospective review of 40 patients who underwent arthroscopic labral debridement of the shoulder. All patients were active participants in sports involving use of the shoulder. All patients presented with shoulder pain. Only 40% were found to have distinct glenohumeral instability on examination. At surgery, all patients had labral injury. Ten patients had anterosuperior labral tears, 20 had anteroinferior labral tears or detachments, and 10 had posteroinferior labral tears or detachments. Outcome was assessed at a minimum of 2 years (average, 43 months) postoperatively. Overall, only 7% of the patients had significant symptomatic relief at followup. However, 72% noted relief of symptoms during the 1st year after surgery, but there was deterioration over time.
Conclusion:
Arthroscopic labral debridement is not an effective long-term solution for symptomatic relief in the overhead athlete.
On shoulder examination, asymmetric scapular posture is often associated to abnormalities of the shoulder complex joint. However, shoulder asymmetries may also be related to adaptations to sports practice. The overhead throwing motion is a highly repetitive skilled motion performed at high velocities. Due to overuse of the dominant overhead-throwing shoulder, athletes may develop some kind of overhead throwing shoulder adaptation pattern that possibly includes scapular asymmetry at the resting position.
To quantify the asymmetry between dominant and non-dominant resting scapular posture in 3 groups of healthy subjects (volleyball players, team-handball players and a control group).
Bilateral 3D scapular kinematics with the arm at rest was measured using a 6 degrees-of-freedom electromagnetic tracking device.
In handball athletes, the dominant scapula was more in internal rotation and anteriorly tilted than in volleyball players. Between athletes and non-athletes groups, the dominant scapula was more anteriorly tilted in the athletes.
Clinicians should be aware that some degree of scapular asymmetry may be normal in some athletes. It should not be considered automatically as a pathological sign but rather an adaptation to sports practice and extensive use of upper limb.
Hypothesis:
In this study, we aim to test whether scapular winging results in a significant change in glenohumeral translation in the initial phase of the throwing motion.
Methods:
Six shoulders underwent an abbreviated throwing motion (ATM) from late cocking to the end of acceleration by use of a validated robotic system. The intact specimens were tested to establish a baseline. The position of the scapula was then affected to simulate scapular winging by placing a cylindrical wedge under the inferior angle of the scapula, and the ATM was performed again. For both conditions, the average glenohumeral translations and scapular rotations were plotted over time to calculate the area under the curve, as a representative of the overall glenohumeral translations and scapular rotations observed during the ATM.
Results:
Throughout the motion, the winged scapulae showed, on average, 7.7° more upward rotation, 1.6° more internal rotation, and 5.3° more anterior tipping as compared with the baseline. The scapular position relative to the hanging arm was significantly different between the baseline and scapular winging conditions in all arm positions, except for maximal external rotation and the neutral position. Comparing the area under the curve at baseline and with scapular winging indicated that scapular winging significantly increased anterior translation of the glenohumeral joint whereas translation in the superior/inferior and medial/lateral directions did not result in a change in translation.
Discussion:
These results may suggest a more important role of abnormalities in scapular position in predisposing throwing athletes to shoulder injuries of the anterior capsulolabral structures and consecutive glenohumeral instability.
Understanding the effect of superior labral lesions on the function of the shoulder is essential to successfully treating the overhead athlete. Recognizing the pseudolaxity due to SLAP lesions and the pathologic “peel-back” sign is critical in evaluating the injured shoulder and repairing the SLAP lesion. The mechanical characteristics of suture anchors are more favorable in resisting the pathologic forces responsible for the peel-back mechanism. The higher success rate of arthroscopic suture anchor repair of SLAP lesions compared with open capsulolabral reconstruction suggests that SLAP lesions are the usual cause of the “dead arm” syndrome. In our experience, arthroscopic repair of SLAP lesions can return the overhead athlete to pre-operative level of function in the vast majority of cases (87% return to pre-operative level for two or more seasons).