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研究生：	李文中 Lee, Wen-Chung
論文名稱：	盂肱關節“鎖定及象限測試”之運動學探討：屍體樣本研究 Kinematic Analyses of the Locking and Quadrant Position Tests of the Glenohumeral Joint: A Cadaveric Study
指導教授：	徐阿田 Hsu, Ar-Tyan
學位類別：	碩士 Master
系所名稱：	醫學院 - 物理治療學系 Department of Physical Therapy
論文出版年：	2007
畢業學年度：	95
語文別：	英文
論文頁數：	83
中文關鍵詞：	鬆動術、盂肱關節、鎖定位置、象限位置、運動學
外文關鍵詞：	glenohumeral joint, quadrant position, kinematics, mobility, Locking position
相關次數：	點閱：92 下載：1
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背景與目的：之前文獻提出鎖定和象限兩種肩關節被動動作不但可以用來測試肩關節較微小程度的疼痛，還可用來測試一般臨床檢查無法發現到的疼痛情形。除此之外，這兩種動作也可用來治療盂肱關節的疼痛。當內轉的肱骨逐漸外展並稍微伸直，直到無法外展為止的位置稱為鎖定姿勢，並且當達到鎖定位置之後將肱骨放鬆使其開始外轉並向水平方向內展時，即開始進入象限位置。
方法：本研究共取樣13個新鮮的盂肱關節，並藉由動作分析系統收集測試資料，且經過解剖後，共選用9個盂肱關節進行數據分析。動作測試主要是在鬆弛、正中、最終，鎖定和象限姿勢下執行，每種姿勢各執行五次，且角度會藉由外展的角度進行標準化。結果分析的部份主要比較肱骨頭和肘關節中心的位移以及關節的角度變化，並利用Friedman’s 測試進行統計分析，p值定為0.05。並用Wilcoxon signed-rank test進行事後檢定，當α<0.017時則表示有顯著差異.
結果：在鎖定測試中，發現肱骨頭會向前和像上移動，並且根據肱骨頭前後方向上的位移發現有三種不同的模式。模式一主要是指肱骨頭向下移動且位置相對於正中位置時較為下方。而另外兩種模式則是僅有少數情況且需要更進一步的驗證。在所有動作測試中也發現肱骨頭最大的位移發生在鬆弛姿勢時，其次為正中姿勢。
結論：在鎖定和象限測試下，發現任何肱骨頭動作模式的改變泛指盂肱關節不正常的關節動作情況，且根據本篇的結果可知，在鬆弛的位置下肱骨頭會有最大的位移。因此，由本篇可得知需在適當的角度下進行鬆動治療技術才能獲得較為有效的成效。

Background and Purpose “Locking” and ”Quadrant” position tests are both passive movements of the shoulder complex developed by Geoffrey Maitland. Both of these tests are able to detect minor degrees of shoulder pain, even in the absence of findings with the application of routine examination or evaluation of the glenohumeral joint. Both of tests can be also applied for the treatment of several glenohumeral joint pathologies. The locking position test involves in abducting the internal rotated and slightly extended humerus until it cannot be moved further into abduction. Once the locking position is found, the internal rotation force is slightly released and the humerus is allowed to external rotate and to horizontal adduct, this is known as the beginning of the quadrant position.
Methods Thirteen fresh glenohumeral joint specimens were used for this study. Vicon Motion Analysis System was used to collect data from a triad marker system attached to the end of the humerus. Mobility tests were performed in the neutral, resting, end range, locking and quadrant positions. The mobility, locking and quadrant position tests were repeated five times. After the dissection process, nine glenohumeral joint specimens were included for data analysis. The abduction angles were normalized to 100%. The method proposed by Gamage and Lasenby was used to estimate the center of rotation of the humerus. Outcomes measures were displacement of the humeral head and elbow joint center, and joint angles. Friedman’s test was used to compare outcome measures with joint angles and positions. Significant level was set at p<0.05. Wilcoxon signed-rank test was used as post hoc comparison method with adjusted Bonferroni value of α<0.017.
Results The humeral head migrated anteriorly and superiorly in the locking position test. Three different patterns were found according to the displacement of the humeral head in the anterior/posterior direction. Pattern I consisted of displacement of the humeral head into posterior and inferior location relative to the neutral position. The other two patterns had smaller sample and needed further verification. The mean maximum displacement of the humeral head for all mobility tests occurred at the resting position followed by the neutral position.
Conclusion Any alterations or variations in the pattern of the humeral head in the locking and quadrant position test could indicate abnormal glenohumeral arthrokinematics. The mean maximum displacement of the humeral head in the mobility tests occurred at the resting position. This could provide an insight for choosing adequate joint position for mobilization techniques.

ABSTRACT……..........I
中文摘要……………........III
致謝……………………...V
TABLE OF CONTENTS………………………VI
FIGURE LIST…………… ..IX
TABLE LIST……………..XI

CHAPTER 1 INTRODUCTION                                              1
1	 Brief description of the anatomy of the shoulder joint………..…………...…1
2	 The “Lock” and “Quadrant” positions test………..………………………….3
3	Kinematics of the glenohumeral joint during functional movement of the shoulder complex…………………………………………....…………..……..8
3.1	Description of the kinematics of the glenohumeral joint during the lock and quadrant position…………………………………………....11
4	Purpose…………………………………………………………………………..13


CHAPTER 2 MATERIALS AND METHODS                                  15
1	Specimen………………………………………………………………................15
2	Specimen preparation…………………………………………………………..15
3	Instrumentations………………………………………………………………..17
4	Experimental Procedures………………………………………………………20
4.1	Lock position test…...………..…………..………………………….…21
4.2	Quadrant position test…..……………….…………………………….21
4.3	Mobility tests…………………………………………………………...22
5	Data Analysis…………………………………………………………………….22

CHAPTER 3 RESULTS                                                   26
1	Estimation of the center of rotation…………………………………………...26
2	Locking position test…………………………………………………………27
3	Quadrant position test………………………………………………………….31
3.1	Quadrant position (Pattern I)………………………………………...32
3.2	Quadrant position (Pattern II)……………………………………......35
3.3	Quadrant position (Pattern III)………………………………………38
4	Mobility tests………………………………………………………………….....39
4.1	AP-PA glide technique…………………………………………………40
4.2	Axial distraction……………………………………………………….43

CHAPTER 4 DISCUSSION                                                45
1	Kinematics of the humeral head and elbow joint during locking and quadrant position tests….…………………………………………………….45
1.1	Locking position test…………………………………………………..45
1.2	Quadrant position test…………………………………………………48
1.2.1	Pattern I……………………………………………………….50
1.2.2	Pattern II……………………………………………………...51
1.2.3	Pattern III…………………………………………………….52
1.2.4	Brief Summary……………………………………………….52
2	Effects of mobility testing on the displacement of the humeral head………..54
2.1	Anterior-Posterior (AP) and Posterior-Anterior (PA) translational mobilization…………………………………………………………….54
2.2	Caudally directed axial distraction…………………………………...56
3	Study limitations………………………………………………………………...57
4	Clinical implications…………………………………………………………….59
CHAPTER 5 CONCLUSION                                               61
REFERENCES AND BIBLIOGRAPHY                                      62
                                    

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校內：2012-09-14公開
校外：2012-09-14公開

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