ANTERIOR SHOULDER INSTABILITY - CONSERVATIVE TREATMENT

Rameni zglob je najpokretljiviji zglob ljudskog tijela i najčešće iščašen zglob upravo zbog njegove građe koja mu omogućava trodimenzionalan pokret, ali i povećava mogućnost ozljede. Potrebna je ravnoteža između stabilnosti i mobilnosti zgloba i one su značajne za potpunu funkciju ramenog zgloba. Nestabilnost ramenog zgloba je klasificirana po tome postoje li traumatski uzrokovana strukturalna oštećenja zgloba, je li uzrok nestabilnosti atraumatski ili se nestabilnost pojavljuje zbog nedostatka mišićne kontrole. Nestabilnost ramena prema naprijed je najčešća kod akutnih traumatskih iščašenja. Za traumatska oštećenja je najčešće indicirano operativno liječenje kako bi se iščašenje uzrokovano poticajnim događajem smanjilo. Ligamentarna labavost ili ponavljajući pokreti mogu dovesti do atraumatske nestabilnosti kod koje je liječenje izbora upitno. Prilikom nedostatka mišićne kontrole bez prisutnih oštećenja strukture zgloba metoda izbora je konzervativno liječenje. Za vraćanje stabilnosti ramenom zglobu potrebno je snažiti mišiće čija je funkcija osiguravanje dinamičke stabilnosti zglobu. Radi se o mišićima rotatorima lopatice i mišićima rotatorne manšete, a kod njih se želi postići optimalna funkcija i ravnoteža u snazi. Uspjeh rehabilitacijskog programa ovisi o ispravnoj procjeni pacijenta, pravovremenom početku i individualiziranom pristupu. Cilj je smanjenje boli i vraćanje motoričke kontrole kako dugoročno pacijent ne bi imao ponovna iščašenja, veća oštećenja i smanjenu funkcionalnost, a posljedično dugotrajnu nestabilnost zgloba. Pretraživanjem PubMeda i PEDra pomoću MeSh termina joint instability, shoulder dislocation, exercise therapy, physical therapy modalities, rehabilitation, conservative treatment i conservative management uz dodatno prikupljanje literature pronađeni su radovi koji su pomoću svojih rezultata i informacija približili temu nestabilnosti ramenog zgloba i postupak rehabilitacije.The shoulder joint is the most mobile joint of the human body and the most commonly dislocated joint precisely because of its structure, which allows it to move in three dimensions, but also increases the possibility of injury. A balance is needed between stability and mobility of the joint, and stability itself is key to the full function of the shoulder joint. Shoulder joint instability is classified according to whether there is traumatic structural damage to the joint, whether the cause of the instability is atraumatic, or whether the instability occurs due to a lack of muscle control. Anterior shoulder instability is most common in acute traumatic dislocations. For traumatic injuries, surgical treatment is most often indicated to reduce the dislocation caused by the stimulus event. Ligament looseness or repetitive movements can lead to atraumatic instability in which the treatment of choice is questionable. In the absence of muscle control without the presence of damage to the joint structure, the method of choice is conservative treatment. To restore stability of the shoulder joint, it is necessary to strengthen the muscles whose function is to ensure dynamic stability of the joint. These are the rotator scapular muscles and the rotator cuff muscles, and the goal for them is to achieve their optimal function and balance in strength. The success of a rehabilitation program depends on proper patient assessment, appropriate initiation, and an individualized approach. The goal is to reduce pain and restore motor control so that in the long run the patient would not have recurrent dislocations, greater damage of the joint and reduced functionality, and consequently long-term joint instability. By searching PubMed and PEDro using MeSh terms joint instability, shoulder dislocation, exercise therapy, physical therapy modalities, rehabilitation, conservative treatment and conservative management with additional literature search, found papers gave results and information for the topic of shoulder instability and rehabilitation procedures