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- 您请求的操作仅限于组中的用户:病因学对内撞击背后的病因学的了解已逐渐发展,但仍不完整。缺乏共同的生物力学模型主要是由于该综合征的患者群体有限,以及已报道的数千例相关病理结果。撞击被描述为一组症状,而不是一种具体的诊断。据认为,许多潜在的病理可能导致撞击症状。肩关节不稳定Meister K.投掷运动员的肩部损伤。第一部分:生物力学/病理生理学/损伤分类。[J] .中华体育杂志2000;28:265-75 ,肩胛骨运动障碍,肩胛运动障碍等。继发性肩撞击综合征的非手术治疗。[J] .中华骨科杂志,1993;17:22 - 24 [/ref> ,在临床文献中,SLAP病变和盂肱内旋缺陷与撞击症状有关。Burkhart SS,等。 The disabled throwing shoulder: spectrum of pathology: Part I: pathoanatomy and biomechanics. Arthroscopy 2003;19:404–20 In general, two pathological mechanisms in the possible aetiology of internal impingement have been described: # excessive humeral translations, compromising glenohumeral congruence, # scapular dyskinesis, decreasing the quality of functional scapular stability.Myers J, Oyama S, Wassinger C, Ricci R, Abt J, Conley K. Reliability, Precision, Accuracy, and Validity of Posterior Shoulder Tightness Assessment in Overhead Athletes. American Journal of Sports Medicine. (2007) 35:1922-1932Myers J, Laudner K, Pasquale M, Bradley J, Lephart S. Posterior Shoulder Tightness in Throwers with Pathologic Internal Impingement. The American Journal of Sports Medicine. (2006) 34:385-391 '''Anterior GH instability:''' Jobe et al. hypothesized that anterior instability/laxity of the shoulder complex caused by repetitive stretching of the anterior GH capsule led to this type of impingement in throwing athletes. This laxity allows for increased anterior humeral head translation.This type of acquired instability is often referred to as acquired instability overuse syndrome (AIOS).Wilk KE, et al. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med 2002;30:136–151 '''Tight posterior GH capsule:''' The posterior-inferior GH joint capsule is hypothesized to become hypertrophied in the follow-through tensile motion of throwing.Preston C, Maison C, House T. Risk Assessment and Prevention of Arm Injuries in Baseball Players. Journal of Musculoskeletal Medicine. (2009) 26:149-153The tightness of the posterior capsule and the muscle tendon unit of the posterior rotator cuff is believed to limit internal joint rotation. Posterior capsule tightness leads to GIRD (glenohumeral internal rotation deficit). Burkhart et al. defined GIRD as a loss of internal rotation of >20° compared with the contralateral side. When the posterior structures of the glenohumeral joint are shortened, this may compromise the hammock function of the inferior glenohumeral ligament (IGHL), and increase the risk for impingement symptoms during throwing. '''Muscle imbalance and/or improper neuromuscular control of the shoulder complex''': Jobe et al. also reported that malpositioning of the arm relative to the glenoid bone during throwing motions can also lead to impingement of the rotator cuff tendons between the glenolabral complex and the humeral head. Fatigue and/or weakness of the scapular retractors have been shown to cause a decreased force production in all four of the rotator cuff muscles, which would also lead to abnormal positioning of the GH joint.Tyler T, Cuoco A, Schachter A, Thomas G, McHugh M. The Effect of Scapular-Retractor Fatigue on External and Internal Rotation in Patients with Internal Impingement. Journal of Sports Rehabilitation. (2009) 18:229-239Mihata T, Gates J, McGarry M, Lee J, Kinoshita M, Lee T. Effect of Rotator Cuff Muscle Imbalance on Forceful Internal Impingement and Peel-Back of the Superior Labrum: A Cadaveric Study. American Journal of Sports Medicine. (2009) 37:2222-2227, At the base of this abnormal scapular positioning lies the lack of neuromuscular control of the periscapular musculature as well as muscle imbalances between the rotator cuff and upward rotators of the scapula (serratus anterior, upper trap, lower trap).