تاندونیت شانه Rotator Cuff Tendonitis
Rotator Cuff Tendonitis تاندونیت روتاتور کاف را معمولا به عنوان تاندونیت شانه می شناسند.
تاندونیت ضایعه ای خفیف و به صورت میکروسکوپی بوده که با مرحله ی التهابی دنبال می شود. تاندونیت ها معمولا ماهیت تخریبی داشته و در بیشتر موارد به علت خستگی بافتی ایجاد می شوند.
در صورت عدم درمان تاندونیت، پارگی کامل یا ناقص یا کلسیفیکاسیون تاندونی ایجاد شده ودر پایان بورس درگیر می شود. شیوع تاندونیت در هر سنی و در هر دو جنس یکسان است. شایع ترین تاندونهایی که درگیر می شوند به ترتیب عبارتند از: سوپرااسپیناتوس، بایسپس، ساب اسکاپولاریس و ترس مینور.
علل شایع تاندونیت عضلات روتاتور کاف
- ضربه های مستقیم به ناحیه.
- اختلالات ساختاری آکرومیون.
- وضعیت نا مناسب مانند پاسچر کایفوتیک یا Rounded Shoulder
- انجام فعالیت های خاص که بیشتر دربالای سر و به شکل تکراری انجام میشوند مثلا در مکانیک ها، نقاش ها و تنیس بازان. در این شرایط میکروترومای تکراری بافت وارد می شود. در حالت طبیعی بافت بدن برای ترمیم نیاز به زمان داشته اما به علت اینکه این افراد به صورت تکراری فعالیت های یکسانی را انجام می دهند زمانی برای ترمیم وجود ندارد
و در این حالت بافت ها ضعیف و استرس های طبیعی نیز سبب بروز آسیب والتهاب د رتاندون ها می شوند.
در مورد علت اصلی تاندونیت سوپرااسپیناتوس موارد زیر نیز ذکر شده است:
در جوانان: سندرم Overuse
در افراد مسن: تغییرات دژنراتیو به علت عدم خون رسانی مناسب تاندون عضله، که به دلایل زیر رخ می دهد:
– Vasculary Mechanism
تاندون این عضله خون رسانی خوبی نداشته و از طرفی، فاقد غلاف سینویال است، به همین دلیل تغییرات دژنراتیو در آن به سرعت رخ داده و ترمیم نیز به کندی صورت می گیرد.
– Biomechanical Mechanism
قسمتی از تاندون (Critical zone) که هایپوواسکولار است حین حرکات شانه در زیر قوس کوراکوآکرومیال تحت فشار قرار گرفته و به همین دلیل زمینه التهاب تاندون را فراهم می سازد.
نکته: عضلات روتاتور کاف کمترین مقاومت را نسبت به نیروی TensileوShear دارند.
نکته: عضلات تراپز فوقانی و پکتورالها در ضایعات شانه دچار اسپاسم شده، در حالی که عضله دلتوئید معمولا مهار می شود.
درمان تاندونیت شانه
در مرحله حاد بیماری: کاهش درد و التهاب در تاندونیت شانه
1- استفاده از داروهای ضد التهاب مانند ایندومایسین.
2- استفاده از یخ ومدالیتی های ضد درد مانند Conventional TENS.
3- تجویز Restبرای بیمار که باید بی حرکتی تقریبا مطلق بوده و وزن اندام تحمل نشود. به همین منظور بالشتکی را در وضعیت 30 درجه تا 40 درجه
Abducthion بازو در زیر بغل قرار داده و دست بیمار را بی حرکت می کنیم. جهت جلوگیری از خشکی مفصل روزی 2 یا 3 مرتبه دست حرکت داده می شود.
4- استفاده از فونوفورزیس هیدرو کورتیزون (ضد التهاب) و لیدوکائین (ضد درد)نیز مفید می باشد.
تمرین درمانی در درمان تاندونیت شانه
1- در این مرحله فقط تمرینات پاندولی آن هم در دامنه بدون درد تجویز می شود. قبل و بعداز تمرینات بیمار نباید درد خاصی را گزارش کند. از طرفی به بیمار توصیه می شود از فعالیت هایی که نیاز به بالا آوردن بازواست خودداری کرده
2- می توان جهت کاهش درد از I Grade وII و تکنیک های موبیلیزاسیون نیز استفاده نمود.
3- مرحله حاد 2 تا 3 روز به طول می انجامد.
در مرحله مزمن بیماری تاندونیت شانه
1- استفاده از گرما و مدالیتی های ضد درد مثل Acupuncture TENS.
2- استفاده از استرچ که بلا فاصله بعد از فروکش کردن علائم التهاب، به کار می رود استرچ باید Pain Free باشد.
در صورت درمان نشدن تاندونیت
به دلیل التهاب در ناحیه، تاندونها ضخیم می شوند، این ضخیم شدگی باعث افزایش اصطکاک تاندون به بافتهای اطراف شده و به این ترتیب احتمال پارگی تاندون افزایش می یابد. در افراد مسن نیز وجود تاندونیت باعث پارگی تاندون می شود. علاوه بر آن با افزایش سن، تاندون ها به صورت غیر الاستیک در آمده واستحکام تاندون برای مقاومت در برابر استرس نرمال از بین می رود، این عوامل همگی منجر به به پارگی تاندون می شوند.
پارگی کامل و ناقص در تاندون عضلات روتاتور کاف
پارگی در تاندونی رخ می دهد که از قبل ضعیف بوده است.
پارگی در نزدیکی محل اتصال تاندون به استخوان و گاهی هم درمرکز تاندون رخ می دهد.
علائم پارگی ناقص سوپرااسپیناتوس
مشابه علائم تاندونیت است اما شدت بیشتری داشته وبیمار درد بسیار زیادی را گزارش می کند.
علائم پارگی کامل سوپرااسپیناتوس
1- درد درابتدا شدید و بعد از مدتی از بین می رود.
2- فرد قادر به انجام حرکتActive نمی باشد.
3- انقباض عضله بدون درد ولی ضعیف است.
4- در حرکات پسیو بیمار مشکلی ندارد.
5- در مواردی که تاندون قطع وحالت جمع شده دارد ممکن است به صورت یک مانع حرکت بازو را محدود کند.
6- فرد معمولا ازShoulder Shrug به جای حرکت از دست رفته در بازو استفاده می کند.
7-Drop Arm Tes t در پارگی عضله سوپرااسپایناتوس مثبت می شود.
8- در صورت پارگی سوپراسپایناتوس در ناحیه آکرومیون یک gap مشاهده می شود
9- درمان اصلی جراحی می باشد.
کلینیک فیزیوتراپی سوگند یکی از بهترین مراکز درمانی در شرق تهران می باشد که جهت درمان تاندونیت شانه در حال ارائه ی خدمات است.
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