理学療法ジャーナル53巻6号

2019年06月発行

特集 上肢運動器疾患—若年者と中高年者の特徴

肩峰下インピンジメント—若年者と中高年者の違い

著者： 上田泰之¹²

所属機関： ¹信原病院リハビリテーション科 ²京都大学大学院人間健康科学系専攻

ページ範囲：P.561 - P.567

はじめに

　肩峰下インピンジメントとは，上肢挙上時に肩峰や烏口肩峰靱帯に肩腱板付着部や肩峰下滑液包が圧迫されることで疼痛を起こす病態である．その原因として上腕骨頭の上方偏位や，肩甲骨上方回旋・後傾・外旋運動の減少（図1），肩腱板腱端部の腫大などが挙げられ，若年者から中高年者まで幅広くみられる．さらにこれらの要因として，肩腱板機能の低下，肩関節包の短縮，前鋸筋・僧帽筋下部線維の機能低下，小胸筋の短縮，肩関節不安定性，胸椎後彎アライメント，胸椎柔軟性の低下が挙げられる．また肩腱板腱端部・肩峰下滑液包の腫大は，肩峰下インピンジメントの結果として起こると考えられるが，これらの要因によりさらに肩峰下インピンジメントのリスクは増大し，悪循環に陥っていく（図2）．本稿では肩峰下インピンジメントの原因について，若年者と中高年者に共通する点，異なる点をそれぞれ述べる．

参考文献

1）Struyf F, et al：Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scand J Med Sci Sports 2011；21：352-358

2）Struyf F, et al：Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. J Electromyogr Kinesiol 2014；24：277-284

3）Kinsella R, et al：Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome：a systematic review. Shoulder Elbow 2017；9：112-126

4）Burkhart SS, et al：The disabled throwing shoulder：spectrum of pathology Part I：pathoanatomy and biomechanics. Arthroscopy 2003；19：404-420

5）Harryman DT, et al：Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am 1990；72：1334-1343

6）Tyler TF, et al：Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med 2000；28：668-673

7）Grossman MG, et al：A cadaveric model of the throwing shoulder：a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am 2005；87：824-831

8）Muraki T, et al：Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med 2010；38：600-607

9）Shiota Y, et al：Contact pressure of the coracoacromial arch in shoulders with joint contracture：a cadaveric study. J Orthop Sci 2017；22：1031-1041

10）Otoshi K, et al：Association between kyphosis and subacromial impingement syndrome：LOHAS study. J Shoulder Elbow Surg 2014；23：e300-e307

11）Finley MA, et al：Effect of sitting posture on 3-dimensional scapular kinematics measured by skin-mounted electromagnetic tracking sensors. Arch Phys Med Rehabil 2003；84：563-568

12）Muraki T, et al：The effect of scapular position on subacromial contact behavior：a cadaver study. J Shoulder Elbow Surg 2017；26：861-869

13）Yamamoto N, et al：Impingement mechanisms of the Neer and Hawkins signs. J Shoulder Elbow Surg 2009；18：942-947

14）Michener LA, et al：Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2015；23：363-369

15）Epstein RE, et al：Hooked acromion：prevalence on MR images of painful shoulders. Radiology 1993；187：479-481

16）Ludewig PM, et al：The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 2009；39：90-104

17）McMahon PJ, et al：Comparative electromyographic analysis of shoulder muscles during planar motions：anterior glenohumeral instability versus normal. J Shoulder Elbow Surg 1996；5（2Pt 1）：118-123

18）Hundza SR, et al：Muscle activation and cutaneous reflex modulation during rhythmic and discrete arm tasks in orthopaedic shoulder instability. Exp Brain Res 2007；179：339-351

19）Borstad JD, et al：The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther 2005；35：227-238

20）Umehara J, et al：Scapular kinematic alterations during arm elevation with decrease in pectoralis minor stiffness after stretching in healthy individuals. J Shoulder Elbow Surg 2018；27：1214-1220

21）Rosa DP, et al：Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain. Physiother Theory Pract 2018：1-9［Epub ahead of print］. doi：10.1080/09593985.2018.1459985

22）Sharkey NA, et al：The rotator cuff opposes superior translation of the humeral head. Am J Sports Med 1995；23：270-275

23）Payne LZ, et al：The combined dynamic and static contributions to subacromial impingement. Am J Sports Med 1997；25：801-808

24）Lin DJ, et al：Shoulder injuries in the overhead-throwing athlete：epidemiology, mechanisms of injury, and imaging findings. Radiology 2018；286：370-387

25）Connor PM, et al：Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes：a 5-year follow-up study. Am J Sports Med 2003；31：724-727

26）上田泰之，他：若年者と高齢者における上肢挙上時の体幹アライメントの違い．体力科学2008；57：485-490

27）Theisen C, et al：Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine--a prospective study with ultrasound-based motion analysis. BMC Musculoskelet Disord 2010；11：135. doi：10.1186/1471-2474-11-135