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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Isolated Pectoralis Minor Release for Scapular Dyskinesis
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Isolated Pectoralis Minor Release for Scapular Dyskinesis

机译：肩P肌运动异常的孤立性胸小肌释放

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Objectives: Pectoralis minor (PM) tightness has been linked to pain and dysfunction of the shoulder joint secondary to anterior tilt and internal rotation of the scapula, causing pseudo-impingement of the subacromial space. Most patients with pathologic tightness of the PM are treated successfully with non-operative treatment, yet a minority of patients experience persistent pain and dysfunction due to a pathologically tight PM. The purposes of this study are to describe the outcomes of operative release of PM tightness recalcitrant to nonoperative measures. Methods: Over a 3-year period, a total of 46 patients were enrolled (mean age 25.5, range 18 to 33) who presented with symptoms of shoulder pain, limited range of overhead motion, and inability to participate in overhead lifting activities, with examination consistent with primary abnormality of scapular dysfunction due to a tight PM with tenderness in the PM tendon. All patients underwent an extended period of physical therapy and stretching program (mean 11.4 months, range 5-23 months), and were followed with serial examinations for resolution of symptoms and scapular tilt. 6/46 (13%) patients were unable to adequately stretch the PM, and underwent isolated mini-open PM release. Outcomes were assessed with scapula protraction measurements, pain scales, and ASES and SANE score. Results: A total of 40/46 (87%) patients resolved the tight PM and scapular mediated symptoms with a dedicated therapy program (ASES 58 to 91; SANE 50 to 90, VAS 4.9 to 0.8, p<0.01). The 6/46 patients treated with isolated PM release demonstrated improvement in outcomes after failed nonoperative care (ASES 48 to 89; SANE 40 to 90.4; VAS 5.8 to 0.9, p<0.01). Overall, protraction of the scapula increased. The inferomedial scapular border was a mean of 1.2 cm from the chest wall preoperatively, and 0.3 cm postoperatively (p<0.01), similar to nonoperative responders. There were no complications and all those with isolated PM release returned to full or increased duties after release. Conclusion: In most patients, PM tightness can be successfully treated with non-operative management. However, in refractory pathologically tight PM cases, this series demonstrates predictable return to function with notable improvement in shoulder symptoms. Additional work is necessary to evaluate the long-term efficiency of isolated PM release.
机译：目的：小胸大肌（PM）的紧缩与继发于前倾和肩internal骨内部旋转继发的肩关节疼痛和功能障碍有关，从而引起肩峰下间隙的假性撞击。大多数患有病理性紧密性PM的患者已通过非手术疗法成功治疗，但是少数患者由于病理性紧密性PM而遭受持续的疼痛和功能障碍。这项研究的目的是描述对非手术措施顽固性PM紧密性的手术释放的结果。方法：在3年的时间里，共有46例患者入组（平均年龄25.5，范围18至33），这些患者出现肩部疼痛症状，仰卧起坐运动幅度有限以及无法参加仰卧起坐活动，检查与原发性肩of功能异常有关，原发性肩PM功能不全是由于过紧的PM伴有PM肌腱压痛。所有患者均接受了延长的物理治疗和拉伸程序（平均11.4个月，范围5-23个月），并进行了系列检查，以缓解症状和肩骨倾斜。 6/46（13％）患者无法充分拉伸PM，并进行了单独的微型开放式PM释放。结果通过肩cap骨前伸测量，疼痛量表以及ASES和SANE评分进行评估。结果：共有40/46（87％）的患者通过专门的治疗计划（ASES 58至91; SANE 50至90，VAS 4.9至0.8，p <0.01）解决了紧张的PM和肩cap骨介导的症状。 6/46例接受单独PM释放的患者在非手术治疗失败后表现出改善的预后（ASES 48至89; SANE 40至90.4; VAS 5.8至0.9，p <0.01）。总体而言，肩骨的长度增加。术前肩骨下缘距胸壁平均1.2 cm，术后0.3 cm（p <0.01），与非手术反应者相似。没有并发症，所有那些单独的PM释放者在释放后可以恢复全部职责或增加职责。结论：在大多数患者中，非手术治疗可成功治疗PM气密性。但是，在难治的病理性紧张性PM病例中，该系列证明了可预测的功能恢复以及肩部症状的明显改善。要评估隔离的PM释放的长期效率，还需要进行其他工作。

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