比較有無肩內轉角度缺損投手之肩關節活動度及肩部穩定性的差異

Comparison of shoulder range of motion and stability between pitchers with and without shoulder internal rotation deficit symptom

10.3966/102472972016094903005

張曉昀(Hsiao-Yun Chang)；鄭世忠(Shih-Chung Cheng)；吳婉鈴(Wan-Ling Wu)；張碧峰(Bi-Fon Chang)

肩部傷害 ； 過肩性運動 ； 棒球 ； 肩部不穩定 ； shoulder injury ； overhead sports ； baseball ； shoulder instability

體育學報

49卷3期（2016 / 09 / 01）

303 - 315

繁體中文

緒論：本研究之目的是比較有無肩關節內轉角度缺損投手之投球手與非投球手肩關節內/外轉活動度及肩部穩定性之差異，以及了解肩關節穩定性與活動度之間的關係。方法：共有15 位大學甲組投手參與 (8 位肩關節內轉角度缺損者及7 位肩關節內轉角度正常者)，使用關節角度計評估投手投球手與非投球手之肩關節內轉、外轉、及內轉加外轉全角度之主動活動度，以及使用測力板測試單肘側邊支撐肩部穩定性測試。以無母數Mann-Whitney U test 分析兩獨立組別的投球手與非投球手之肩關節活動度及肩關節穩定性數值之差異，及皮爾森積差相關與簡單線性迴歸分析投球手的肩關節活動度與肩關節穩定性之關係。結果：肩關節活動度測量中，缺損組在投球手的肩外轉角度比正常組大 (p= .04)，其餘關節活動度並未有差異 (p ＞ .05)；肩關節穩定性測量中，擺盪面積呈現缺損組比正常組大 (p = .04)，顯示缺損組有較差的肩關節穩定性，而擺盪距離與擺盪速度則無差異。肩關節擺盪距離及擺盪速度與肩內轉角度呈現中度負相關 (p = .03)，且可以迴歸公式y = -0.038x+56.903 使用肩內轉角度預測肩關節的穩定性 (x：肩關節內轉角度；y：肩擺盪距離；R^2 = 0.309, F (1,13) = 5.825, p = .03)。結論：肩內轉角度缺損投手在肩外轉角度較大、肩部穩定性較差，且當投手的肩內轉活動度增加，肩關節穩定性隨之增加。

Introduction: Shoulder pain and instability often occurs in baseball pitchers. The shoulder pain and instability may come from the glenohumeral internal rotation deficit (GIRD). The purpose of this study was to compare the difference and relationship of shoulder range of motion (ROM) and shoulder stability between pitchers with and without GIRD. Methods: Fifteen pitchers participated in this study (8 pitchers with GIRD and 7 pitchers without GIRD). The shoulder internal / external rotation, and shoulder total range were measured by using goniometer for both arms. The Zebris force platform was used to assess the shoulder stability with using lateral single elbow supports dynamic stability test. The non-parametric Mann-Whitney U test was used to compare the difference between pitchers with and without GIRD. Pearson's coefficient of correlation and simple linear regression was used to analyze the relationship between shoulder range of motion and stability. Results: The result was showed that the pitchers with GIRD symptom had more laxity in shoulder external rotation than pitchers without GIRD in throwing arm (p ＜ .05), and no significant different was found in others measurement of shoulder ROM. Pitcher with appearing GIRD was found to have poor shoulder stability (p ＜ .05) when comparing with pitcher who has no GIRD symptom. The moderated negative relationships were found among sway path length, velocity of shoulder stability test and shoulder internal rotation ROM (p ＜ .05). The regression formation: y=-0.038x+56.903 (x: shoulder internal rotation ROM; y: sway path length of shoulder stability test). It was meant that the shoulder internal rotation deficit could predict the shoulder stability. Conclusion: It had relieved that the pitchers with GIRD symptom has more laxity degree in shoulder external rotation and poor shoulder stability. It is also showed more ROM of shoulder internal rotation, more shoulder stability.

1. 林謙如、張曉昀(2014)。單側性與雙側性過肩運動之肩關節活動度特徵：游泳與網球之比較。體育學報，47(1)，35-45。
   連結：
2. 洪敏豪、林謙如、吳國輝、張曉昀(2012)。游泳、棒球、及網球選手肩關節活動度的差異。華人運動生物力學期刊，7，163-164。
   連結：
3. 楊明達、詹貴惠(2006)。藥球訓練對棒球運動員投球表現與敏捷性的影響。運動生理暨體能學報，5，149-155。
   連結：
4. 劉佳哲(2013)。健康網球選手肩部肌力與關節活動度之關係。體育學報，46(2)，131-141。
   連結：
5. 劉強(2009)。棒球投手等速肌力與揮臂速度對投擲不同重量棒球之投球影響。體育學報，42(3)，1-16。
   連結：
6. 鄭世忠、張曉昀、陳百鍊、楊卿潔(2011)。棒球投手盂肱關節內旋活動度缺損：可能傷害機轉與預防之道。運動教練科學，24，1-12。
   連結：
7. Castellano, P. (2006). Twins Baseball minor League strength and condition manual. Retrived from http://minnesota.twins.mlb.com/min/community/training.jsp
8. Baltaci, G.,Johnson, R.,Kohl, H.(2001).Shoulder range of motion characteristics in collegiate baseball player.The Journal of Sports Medicine and Physical Fitness,41,236-242.
9. Bigliani, L. U.,Codd, T. P.,Connor, P. M.,Levine, W. N.,Littlefield, M. A.,Hershon, S. J.(1997).Shoulder motion and laxity in the professional baseball player.American Journal of Sports Medicine,25,609-613.
10. Brown, L. P.,Niehues, S. L.,Harrah, A.,Yavorsky, P.,Hirshman, H. P.(1988).Upper extremity range of motion and isokinetic strength of the internal and external shoulder rotators in major league baseball players.American Journal of Sports Medicine,16(6),577-585.
11. Burkhart, S. S.,Morgan, C. D.,Kibler, W. B.(2003).The disabled throwing shoulder: Spectrum of pathology part III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation.Arthroscopy,19(6),641-661.
12. Burkhart, S. S.,Morgan, C. D.,Kibler, W. B.(2003).The disabled throwing shoulder: Spectrum of pathology part I: Pathoanatomy and biomechanics.Arthroscopy,19(4),404-420.
13. Clabbers, K. M.,Kelly, J. D.,Bader, D.,Eager, M.,Imhauser, C.,Siegler, S.,Moyer, R. A.(2007).Effect of posterior capsule tightness on glenohumeral translation in the late cocking phase of pitching.Journal of Sport Rehabilitation,16(1),41-49.
14. Donatelli, R.,Ellenbecker, T. S.,Ekedahl, S. R.,Wilkes, J. S.,Kocher, K.,Adam, J.(2000).Assessment of shoulder strength in professional baseball pitchers.The Journal of Orthopaedic and Sports Physical Therapy,30,544-551.
15. Downar, J. M.,Sauers, E. L.(2005).Clinical measures of shoulder mobility in the professional baseball players.Journal of Athletic Training,40,23-29.
16. Dwelly, P. M.,Tripp, B. L.,Tripp, P. A.,Eberman, L. E.,Gorin, S.(2009).Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season.Journal of Athletic Training,44(6),611-616.
17. Ellenbecker, T. S.,Roetert, E. P.,Bailie, D. S.,Davies, G. J.,Brown, S. W.(2002).Glenohumeral joint total rotation range ofmotion in elite tennis players and baseball pitchers.Medicine and Science in Sports and Exercise,34,2052-2056.
18. Fleisig, G. S.,Andrews, J. R.,Dillman, C. J.,Escamilla, R. F.(1995).Kinetics of baseball pitching with implications about injury mechanisms.American Journal of Sports Medicine,23(2),233-239.
19. Fleisig, G. S.,Barrentine, S. W.,Escamilla, R. F.,Andrews, J. R.(1996).Biomechanics of overhand throwing with implications for injuries.Sports Medicine,21(6),421-437.
20. Fusco, A.,Foglia, A.,Musarra, F.,Testa, M.(2008).The shoulder in sport: Management, rehabilitation and prevention.London, UK:Churchill Livingstone, Elsevier Ltd..
21. Gates, J. J.,Gupta, A.,McGarry, M. H.,Tibone, J. E.,Lee, T. Q.(2012).The effect of glenohumeral internal rotation deficit due to posterior capsular contracture on passive glenohumeral joint motion.American Journal of Sports Medicine,40(12),2794-2800.
22. Hurd, W. J.,Kaplan, K. M.,Eiattrache, N. S.,Jobe, F. W., Morrey, B. F.,Kaufman, K.R.(2011).A profile of glenohumeral internal and external rotation motion in the uninjured high school baseball pitcher.Journal of Athletic Training,46(3),282-288.
23. Kibler, W. B.,Chandler, T. J.,Livingston, B. P.,Roetert, E. P.(1996).Shoulder range of motion in elite tennis players: Effect of age and years of tournament play.American Journal of Sports Medicine,24,279-285.
24. Kibler, W. B.,Sciascia, A.,Thomas, S. J.(2012).Glenohumeral internal rotation deficit: Pathogenesis and response to acute throwing.Sports Medicine and Arthroscopy Review,20(1),34-38.
25. Laudner, K. G.,Sipes, R. C.,Wilson, J. T.(2008).The acute effects of sleeper stretches on shoulder range of motion.Journal of Athletic Training,43(4),359-363.
26. Magee, D. J.(2013).Orthopedic physical assessment.St. Louis, Missouri:Saunders, Elsevier Inc..
27. Myers, J. B.,Guskiewicz, K. M.,Schneider, R. A.,Prentice, W. E.(1999).Proprioception and neuromuscular control of the shoulder after muscle fatigue.Journal of Athletic Training,34(4),362-367.
28. Myers, J. B.,Wassinger, C. A.,Lephart, S. M.(2006).Sensorimotor contribution to shoulder stability: Effect of injury and rehabilitation.Manual Therapy,11(3),197-201.
29. Prentice, W. E.(2003).Arnheim's Principles of Athletic Training. A competency-Based Approach.New York, NY:McGraw-Hill Companies, Inc..
30. Reagan, K. M.,Meister, K.,Horodyski, M. B.,Werner, D. W.,Carruthers, C.,Wilk, K.(2002).Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players.American Journal of Sports Medicine,30(3),354-360.
31. Reinold, M. M.,Wilk, K. E.,Macrina, L. C.,Sheheane, C.,Dun, S.,Fleisig, G. S.,Andrews, J. R.(2008).Changes in shoulder and elbow passive range of motion after pitching in professional baseball players.American Journal of Sports Medicine,36,523-527.
32. Shanley, E.,Rauh, M. J.,Michener, L. A.,Ellenbecker, T. S.,Garrison, J. C.,Thigpen, C. A.(2011).Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players.American Journal of Sports Medicine,39(9),1997-2006.
33. Shanley, E.,Thigpen, C. A.,Clark, J. C.,Wyland, D. J.,Hawkins, R. J.,Noonan, T. J.,Kissenberth, M. J.(2012).Changes in passive range of motion and development of glenohumeral internal rotation deficit (GIRD) in the professional pitching shoulder between spring training in two consecutive years.Journal of Shoulder and Elbow Surgery,21(11),1605-1612.
34. Tehranzadeh, A. D.,Fronek, J.,Resnick, D.(2007).Posterior capsular fibrosis in professional baseball pitchers: Case series of MR arthrographic findings in six patients with glenohumeral internal rotational deficit.Clinical Imaging,31(5),343-348.
35. Thomas, S. J.,Swanik, K. A.,Swanik, C.,Huxel, K. C.(2009).Glenohumeral rotation and scapular position adaptations after a single high school female sports season.Journal of Athletic Training,44(3),230-237.
36. Torres, R. R.,Gomes, J. L.(2009).Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers.American Journal of Sports Medicine,37(5),1017-1023.
37. Trakis, J. E.,McHugh, M. P.,Caracciolo, P. A.,Busciacco, L.,Mullaney, M.,Nicholas, S.J.(2008).Muscle strength and range of motion in adolescent pitchers with throwing-related pain: Implications for injury prevention.American Journal of Sports Medicine,36(11),2173-2178.
38. Wilk, K. E.,Hooks, T. R.,Macrina, L. C.(2013).The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete.The Journal of Orthopaedic and Sports Physical Therapy,43(12),891-894.
39. Wilk, K. E.,Macrina, L. C.,Fleisig, G. S.,Porterfield, R.,Simpson, II C. D.,Harker, P.,Andrews, J. R.(2011).Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.American Journal of Sports Medicine,39(2),329-335.
40. Yang, J. l.,Chen, S. Y.,Chang, C. W.,Lin, J. J.(2009).Quantification of shoulder tightness and associated shoulder kinematics and functional deficits in patients with stiff shoulders.Manual Therapy,14(1),81-87.
41. Yoshida, M.,Saho, Y.,Katayose, M.(2010).Reliability of measuring humeral retroversion using ultrasound imaging in a healthy nonthrowing population.Journal of Sport Rehabilitation,19(2),149-160.
42. 陳冠文、蔡永裕(2012)。青少年棒球選手手肘內側疼痛與肩關節旋轉活動度之關係。澄清醫護管理雜誌，8(1)，9-14。
43. 陳星宇、張曉昀、鍾宇政(2008)。健康棒球投手慣用側與非慣用側肩關節穩定性之研究。2008 年臺灣運動生物力學學會及臺灣生物力學學會聯合年會暨學術研討會，臺中市，臺灣=Taichung, Taiwan:
44. 楊長彬、陳昭瑩、蕭逸氏、林永福(2004)。大專棒球運動員肩關節活動度與肌力之評量。北市醫學雜誌，1(3)，331-343。

1. 黃子涵,周昆佑,吳婉鈴(2022)。青少年女性排球選手肩部及軀幹活動度特徵。華人運動生物力學期刊，19(2)，32-39。