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Physiotherapeutic care of patient with diagnostics of the impingement syndrome
BUŘILOVÁ, Pavlína
This thesis deals with the issue of physiotherapeutical care of patients diagnosed with impingement syndrome of arteculatio humeri. Impingement syndrome means an oppression or distress in the area of arteculatio humeri. That signifies an oppression of tendon m. supraspinatus in the subacromial area.It is clinically demonstrated by pain and functional limitation of movement and is caused by an overload of rotator cuff and its oppression with traumatic changes in the area of subacromial area.The most important information from kinesiology and biomechanics of arteculatio humeri are described in the theoretical part of the thesis. The possible causes of the development of impingement syndrome in different age ranges, individual stages and possible treatment methods are included too.For the research part of the thesis I used the method of qualitative research and investigative and therapeutic methods. In the kinesiological analysis I used the investigative methods according to Janda (muscle test and the test of abbreviated muscles), investigation of arthral free play according to Rychlíková, goniometric examination, visual inspection and palpation and examination of reflective changes according to Lewit. In the proposed procedures of physiotherapy the methods of soft tissues, postisometric muscle relaxation according to Lewit (including subsequent stretching), mobilization according to Rychlíková, PNF according to Kabat, respiratory physiotherapy and kryotherapy were used. I used interviews and observations to gather the data. The research file consisted of three patients who were recommended by orthopedic doctor for the surgical solution of impingement syndrome. The whole amount of time dedicated to the actual research was two months for the first two patients and three months for the third one. The patients were informed about the progress and goal of the therapy. The goal of this work was to compile the issues of impingement syndrome and describe the theoretical foundation of the area of kinesiology of arteculatio humeri.The second goal was to describe the physiotherapeutic possibilities and its practical efficiency in the research part. At the beginning of the research, the investigatory question was chosen: Which procedure of physiotherapy is efficient? The process and results rated and judged during the operational solution of impingement syndrome of arteculatio humeri were. The therapy of two of the patients was efficient. The edema, range of movement,muscular strength was modified and the respiratory stereotype and abduction stereotype was enhanced. The third patient, who was subjected to the revision of rotator cuff, did not reach the optimal results because of the short stretch time of therapy. The first six weeks of the therapy consisted of passive movements and in the next six weeks the active exercises were introduced to affect the muscular strength and interplay when moving. The results were also affected by a fall that resulted in a fracture in the Th12 area, treated in conservative way. The period of six weeks is too short to affect the quality of movement in full range in this case. Nevertheless, the clinical state was improved according to the output examination and the therapy was evaluated as efficient. The frequency of pain was lowered and the edema, range of movement in arteculatio humeri was adjusted, the muscular strength increased and the respiratory stereotype was modified. The results of research part showed that the methods used in the therapeutic part were effective and thus the goal of the research was fulfilled. The contents of this thesis are going to be available to the physiotherapeutic public. It can be beneficial in the clinical practice because it calls attention to the impingement syndrome and the possible procedures of physiotherapy.
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