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Effects of Thoracic Spine Mobility Exercise on Symptom Improvement and Scapular Position in Patient with Subacromial Impingement Syndrome
Korean J Sports Med 2022;40:12-21
Published online March 1, 2022;  https://doi.org/10.5763/kjsm.2022.40.1.12
© 2022 The Korean Society of Sports Medicine.

Moon-Young Choi1,2, Doo-Hwan Kong1,2, Jin-Seong Kim1,2, Suk-Hwan Jang1,2

1Department of Orthopedic Surgery and Sports Medical Center, Seoul Paik Hospital, Seoul,
2Sports Medical Research Institute, Inje University, Seoul, Korea
Correspondence to: Suk-Hwan Jang
Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea
Tel: 竊82-2-2270-0028, Fax: 竊82-2-2270-0023, E-mail: jsh@paik.ac.kr
Received September 3, 2021; Revised December 2, 2021; Accepted December 2, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: The purpose of this study was to identify effects of the thoracic spine mobility exercise in patients with subacromial impingement syndrome (SIS).
Methods: Twenty patients diagnosed with SIS were selected and randomized into the combination exercise (CE) group (n=10) and shoulder exercise (SE) group (n=10). Both groups performed the same SE program for 12 weeks, and CE group performed the thoracic spine mobility exercises additionally. Before and after the exercises, visual analogue scale (VAS), shoulder range of motion (ROM), thoracic spine mobility, American Shoulder and Elbow Surgeons Shoulder Score (ASES) and Constant score, isokinetic strength, and scapula position were assessed.
Results: After 12 weeks of exercise intervention, there were significant improvements in VAS, thoracic spine mobility, ASES, isokinetic shoulder external rotation, and abduction strength in the CE group (p< 0.05). However, there were no significant interaction effects between the groups in shoulder ROM, Constant score, isokinetic shoulder internal rotation, and adduction strength. With scapular position, the internal rotation, anterior tilting, and protraction angles were significantly decreased after thoracic spine mobility exercise in the CE group (p< 0.05).
Conclusion: The symptoms and scapular positions of patients with SIS showed more improvement when the thoracic spine mobility exercises were performed in combination with shoulder exercises compared to shoulder exercises only.
Keywords : Muscle strength, Scapula, Shoulder, Subacromial impingement syndrome, Thoracic vertebrae
꽌 濡

寃щ큺븯 異⑸룎利앺썑援(subacromial impingement syndrome) 寃щ큺怨 긽셿怨⑤몢 궗씠쓽 怨듦컙씠 醫곸븘吏硫 寃щ큺 븘옒쓽 뿰遺 議곗쭅뱾뿉 留뚯꽦쟻씤 븬諛뺢낵 異⑸룎씠 媛빐졇 넻利앹쓣 쑀諛쒗븯뒗 긽깭濡 긽吏 嫄곗긽 떆 寃щ큺븯 솢븸궘(subacromial bursa), 씠몢洹 옣몢嫄(biceps long head tendon), 쉶쟾洹쇨컻 嫄(rotator cuff tendon)씠 寃щ큺쓽 쟾븯硫댁뿉꽌 諛쒖깮븯뒗 븬諛뺤뿉 쓽빐 뿼利 諛섏쓳쓣 씪쑝궎硫 諛쒖깮븳떎1. 寃ш젅쓽 吏곸엫 빐遺븰쟻, 깮泥댁뿭븰쟻쑝濡 寃ш컩怨④낵 諛젒븯寃 愿젴릺硫 寃ш컩怨 吏곸엫뿉 蹂솕媛 깮湲곕㈃ 寃ш젅쓽 湲곕뒫怨 븞젙꽦뿉룄 겙 쁺뼢쓣 誘몄튇떎2. 寃ш컩怨⑥쓽 吏곸엫 쓨異붿쓽 媛룞꽦뿉 겕寃 쁺뼢쓣 諛쏅뒗뜲, 怨쇰룄븳 쓨異 썑留(thoracic kyphosis) 寃ш컩怨④낵 긽셿怨⑥쓽 愿怨꾨 蹂솕떆耳 寃ш젅 蹂듯빀泥댁쓽 洹쇰젰쓣 빟솕떆궎怨, 愿젅긽셿愿젅쓽 愿젅 媛룞 踰붿쐞(range of motion, ROM)瑜 젣븳븯뿬 寃щ큺븯 異⑸룎利앺썑援곗쓽 蹂묐━븰쟻 썝씤씠 맂떎3. 삉븳 遺쟻젅븳 쓨異 옄꽭뒗 쓨怨쎌뿉 븳 寃ш컩怨⑥쓽 쟾씤, 궡쉶쟾, 븯諛⑺쉶쟾쓣 쑀諛쒗븯뒗뜲, 씠윭븳 쐞移 蹂솕뒗 寃щ큺쓣 쟾븯諛⑹쑝濡 뼢븯寃 븯뿬 寃щ큺븯 怨듦컙(subacromial space)쓣 媛먯냼떆耳 寃ш젅쓽 異⑸룎 쐞뿕씠 利앷븳떎4,5. 씠뿉 뵲씪 理쒓렐 寃щ큺븯 異⑸룎利앺썑援 솚옄뱾쓣 긽쑝濡 쓨異붿쓽 젣븳맂 吏곸엫쓣 利앹쭊븯뒗 媛룞꽦 移섎즺쓽 븘슂꽦怨 슚怨쇨 끉쓽릺硫 以묒슂꽦씠 媛뺤“릺怨 엳떎6-8. 뿬윭 꽑뻾뿰援ъ뿉꽌 쓨異붿쓽 媛룞꽦 利앷媛 寃щ큺븯 異⑸룎利앺썑援 솚옄뱾쓽 寃ш젅 넻利 媛먯냼 利앹긽 媛쒖꽑뿉 以묒슂븳 쁺뼢쓣 誘몄튂뒗 寃껋쑝濡 蹂닿퀬븯吏留, 씠瑜 移섎즺븯湲 쐞븳 以묒옱뿉꽌 쓨異붽룞꽦 슫룞쓽 슚怨쇱뿉 븳 뿰援щ뒗 遺議깊븳 떎젙씠떎. 뵲씪꽌 蹂 뿰援ъ뿉꽌뒗 쓨異붽룞꽦 슫룞쓣 寃ш젅 슫룞怨 蹂듯빀 떎떆븯쓣 븣 寃щ큺븯 異⑸룎利앺썑援 솚옄쓽 寃ш젅 넻利, ROM, 湲곕뒫, 洹쇰젰 쉶蹂 諛 寃ш컩怨 쐞移섏뿉 誘몄튂뒗 쁺뼢쓣 솗씤븯怨좎옄 븯떎.

뿰援щ갑踰

1. 뿰援щ긽 諛 꽕怨

蹂 뿰援щ뒗 꽌슱떆 以묎뎄뿉 쐞移섑븳 꽌슱諛깅퀝썝쓽 엫긽뿰援ъ떖쓽쐞썝쉶쓽 듅씤쓣 諛쏆 썑 긽옄瑜 紐⑥쭛븯떎(No. PAIK 2016-08-005). 紐⑤뱺 긽옄뱾뿉寃 뿰援ъ쓽 紐⑹쟻怨 젅李⑥뿉 빐 異⑸텇엳 꽕紐낇븯쑝硫, 옄諛쒖쟻쑝濡 꽌紐낇븳 꽌硫대룞쓽꽌瑜 諛쏆븯떎. 긽옄뒗 꽌슱諛깅퀝썝뿉꽌 젙삎쇅怨 쟾臾몄쓽媛 씠븰쟻 寃궗(physical examination) 諛⑹궗꽑븰쟻 寃궗(radiologic examination)瑜 넻빐 寃щ큺븯 異⑸룎利앺썑援곗쓣 吏꾨떒븯怨, 移섎즺瑜 쐞빐 슫룞 以묒옱媛 븘슂븯떎怨 뙋떒븯뿬 쓽猶고븳 솚옄濡 쉶쟾洹쇨컻 뙆뿴 냼寃ъ씠 뾾怨, 湲고 寃ш젅 蹂묐뿉 븳 닔닠 蹂묐젰씠 뾾쑝硫, 뿰援 醫낅즺 떆源뚯 二쇱궗 諛 룄닔移섎즺(manipulation) 벑쓽 떎瑜 移섎즺瑜 諛쏆 븡怨 젙빐吏 슫룞 봽濡쒓렇옩쓣 닔뻾븷 쓽吏瑜 媛吏 留 40–59꽭 궗씠쓽 꽦씤뿉꽌 꽑젙븯떎. 洹 以 쇅긽꽦 湲됱꽦 넀긽뿉 쓽빐 寃ш젅 넻利앹쓣 샇냼븯嫄곕굹 泥숈텛 吏덊솚쑝濡 쓨異붽룞꽦 슫룞 떎떆뿉 젣븳씠 엳뒗 궗엺, 泥숈텛瑜 닔닠븳 蹂묐젰쓣 媛吏怨 엳뒗 궗엺, 떖媛곹븳 怨⑤떎怨듭쬆씠 엳嫄곕굹 뿰援 씠쟾遺꽣 씠誘 떎瑜 移섎즺瑜 諛쏄퀬 엳뒗 궗엺 꽑蹂꾩쓣 넻빐 젣쇅븯怨 理쒖쥌 20紐낆쓣 紐⑥쭛븯떎. 쇅옒 吏꾨즺 씠썑 슫룞 援먯쑁쓣 諛쏄린 쐞빐 諛⑸Ц븳 닚꽌濡 긽옄 踰덊샇瑜 遺뿬븯怨, 궃닔몴瑜 궗슜빐 臾댁옉쐞濡 쓨異붽룞꽦 슫룞怨 寃ш젅 슫룞쓣 蹂듯빀 떎떆븯뒗 援(combination exercise [CE] group, n=10)怨 떒씪 寃ш젅 슫룞留 떎떆븯뒗 援(shoulder exercise [SE] group, n=10)쑝濡 遺꾨쪟븯떎. 理쒖큹 諛⑸Ц씪쓣 뿰援 떆옉씪濡 꽕젙븯뿬 궗쟾 寃궗瑜 떎떆븯쑝硫, 12二쇨컙 二 2씪 꽱꽣뿉 諛⑸Ц븯뿬 吏룄媛먮룆 븯뿉 슫룞쓣 떎떆븯怨, 二 5씪 슫룞 봽濡쒓렇옩 쑀씤臾쇱쓣 젣怨듯븯뿬 吏묒뿉꽌 옄媛 슫룞쓣 蹂묓뻾븯寃 븯떎. 理쒖쥌쟻쑝濡 12二 씠썑 뿰援 醫낅즺씪뿉 궗쟾怨 룞씪븳 궗썑 寃궗瑜 떎떆븯뿬 빐떦 寃궗쓽 異붿떆 寃곌낵瑜 遺꾩꽍븯떎.

2. 슫룞 봽濡쒓렇옩

쓨異붽룞꽦 슫룞 봽濡쒓렇옩 씤泥댁쓽 湲곕뒫빐遺븰쟻 吏곸엫뿉 븳 洹쇨굅 씠쟾 꽑뻾뿰援щ뱾뿉꽌 寃利앸맂 봽濡쒓렇옩뱾쓣 李멸퀬븯뿬 援ъ꽦븯떎(Fig. 1)3,9-13. 뒳愿젅怨 怨좉젅쓣 源딄쾶 援닿끝븳 옄꽭뿉꽌뒗 怨⑤컲씠 썑諛⑹쑝濡 湲곗슱뼱吏硫 몦洹쇨낵 뻹뒪듃留곸씠 닔룞 떊옣(passive stretch)릺뼱 슂異붾 렪룊븯寃 留뚮뱾湲 븣臾몄뿉 쓨異 떊쟾 떆 슂異붿쓽 蹂댁긽쟻 怨쇱떊쟾쓣 젣븳븷 닔 엳떎怨 蹂닿퀬븳 Keegan13쓽 뿰援щ 諛뷀깢쑝濡, 쓨異 떊쟾 슫룞 뒳愿젅怨 怨좉젅쓣 理쒕븳 援닿끝븳 옄꽭뿉꽌 떎떆븷 닔 엳룄濡 援ъ꽦븯떎. 寃ш젅 슫룞 봽濡쒓렇옩 異⑸룎利앺썑援 솚옄瑜 쐞븳 洹쇨굅 湲곕컲 옱솢 諛⑸쾿뿉 빐 蹂닿퀬븳 Ellenbecker Cools14쓽 뿰援ъ, 뼱源 湲곕뒫 쉶蹂듭쓣 쐞븳 옱솢뿉꽌 寃ш컩怨 븞젙솕瑜 媛뺤“븳 Kibler 벑15쓽 뿰援ъ뿉꽌 寃利앸맂 슫룞 봽濡쒓렇옩쓣 李멸퀬븯뿬 援ъ꽦븯떎(Table 1). 슫룞 떆옉 쟾 궗쟾 援먯쑁怨 떆踰붿쓣 넻빐 룞옉뿉 븳 씠빐瑜 룄솕쑝硫, 슫룞 닚꽌뒗 以鍮꾩슫룞, 蹂 슫룞, 젙由ъ슫룞쑝濡 援ъ꽦븯떎. 以鍮꾩슫룞怨 젙由ъ슫룞 쟾떊 泥댁삩 긽듅 諛 삁븸닚솚쓣 珥됱쭊븯湲 쐞빐 移대낫꽙 怨듭떇16쑝濡 궛異쒗븳 40%–60% 슫룞 媛뺣룄뿉 빐떦븯뒗 紐⑺몴 떖諛뺤닔 踰붿쐞뿉꽌 蹂 슫룞 쟾썑뿉 10遺꾩뵫 듃젅뱶諛 쐞뿉꽌 嫄룰린 슫룞쓣 닔뻾븯쑝硫, 蹂 슫룞 젣븳맂 吏곸엫쓽 쉶蹂듭쓣 쐞븳 媛룞꽦 슫룞怨 빟솕맂 洹쇱쑁쓽 媛뺥솕瑜 쐞븳 洹쇰젰 슫룞쑝濡 援ъ꽦븯떎. 媛룞꽦 슫룞 떊옣맂 옄꽭瑜 10珥덇컙 쑀吏븯뿬 10쉶뵫 1꽭듃 닔뻾븯怨, 洹쇰젰 슫룞 15쉶瑜 븳 꽭듃濡 珥 3꽭듃뵫 닔뻾븯떎.

Table 1 . Exercise program

Period (wk)Combination exercise groupShoulder exercise group
1−3Shoulder AAROM exercise
4−6Shoulder AROM exercise竊땤horacic spine mobility exerciseShoulder AROM exercise
7−9Periscapular muscles strengthening竊땤horacic spine mobility exercisePeriscapular muscles strengthening
10−12Shoulder muscles strengthening竊땤horacic spine mobility exerciseShoulder muscles strengthening

AAROM: active assisted range of motion, AROM: active range of motion.


Fig. 1. Thoracic spine mobility exercise program. (A) Bench thoracic extension. (B) Kneeling sphinx pose. (C) Foam roller thoracic extension. (D, E) Thoracic cat-cow stretch. (F) Seated thoracic rotation. (G) Supine thoracic rotation. (H) Sidelying thoracic rotation. (I) Quadruped thoracic rotation. (J) Half-kneeling thoracic rotation.

3. 痢≪젙 빆紐 諛 諛⑸쾿

1) 寃ш젅 넻利(shoulder pain)

寃ш젅쓽 넻利앹 떆媛 븘궇濡쒓렇 泥숇룄(visual analogue scale, VAS)瑜 궗슜븯뿬 10 cm쓽 닔룊꽑 쐞뿉 醫뚯륫뿉꽌遺꽣 슦痢≪쑝濡 0젏(넻利앹씠 쟾 뾾쓬)뿉꽌 10젏(媛옣 洹뱀떖븳 理쒖븙쓽 넻利) 궗씠쓽 吏젏뿉 솚옄媛 뒓겮뒗 二쇨쟻씤 넻利앹쓽 젙룄瑜 吏곸젒 몴떆븯寃 븯뒗 諛⑸쾿쑝濡 痢≪젙븯떎17.

2) 寃ш젅 愿젅 媛룞 踰붿쐞(shoulder range of motion)

寃ш젅쓽 ROM 愿젅 媛곷룄怨(goniometer)瑜 궗슜빐 痢≪젙븯떎. 솚옄媛 벑쓣 怨 諛붾Ⅴ寃 늻슫 옄꽭(supine position)뿉꽌 泥닿컙쓣 怨좎젙븯怨, 愿젅 媛곷룄怨꾩쓽 異뺤쓣 愿젅쓽 빐遺븰쟻 異뺤뿉 씪移섏떆耳 痢≪젙븯떎. 쟾諛 援닿끝怨 쇅쟾 빐遺븰쟻 옄꽭뿉꽌 痢≪젙븯쑝硫, 궡쉶쟾怨 쇅쉶쟾 寃ш젅씠 90° 쇅쟾맂 옄꽭뿉꽌 痢≪젙븯떎.

3) 쓨異붽룞꽦(thoracic spine mobility)

쓨異붿쓽 떊쟾 媛룞꽦 X-ray 씠誘몄瑜 넻빐 룊媛븯떎. 슂異붿 怨⑤컲쓽 蹂댁긽쟻씤 吏곸엫쓣 理쒖냼솕븯湲 쐞빐 怨좉젅怨 臾대쫷쓣 90° 援닿끝븯怨 쓽옄뿉 븠 긽깭뿉꽌 理쒕 떊쟾 옄꽭瑜 lateral view濡 珥ъ쁺븳 떎쓬18, 쓽猷 쁺긽 옣 쟾넚 떆뒪뀥씤 picture archiving and communication system (PACS) m-view 5.4瑜 궗슜빐 3–4踰 쓨異붿쓽 泥숈텛 以묒떖(vertebral centroids)쓣 媛濡쒖瑜대뒗 꽑怨 10–11踰 쓨異붿쓽 泥숈텛 以묒떖쓣 媛濡쒖瑜대뒗 꽑쓣 꽌濡 援먯감떆耳 泥숈텛 以묒떖媛(vertebral centroid angle)쓣 痢≪젙븯떎(Fig. 2)19. 쓨異붿쓽 쉶쟾 媛룞꽦 떊쟾 寃궗 룞씪븳 옄꽭뿉꽌 臾대쫷 궗씠뿉 怨듭쓣 怨 궡痢≪쑝濡 議곗씠뒗 룞옉쓣 異붽븯뿬 泥닿컙 쉶쟾 떆 怨좉젅쓽 蹂댁긽쟻씤 吏곸엫쓣 理쒖냼솕븯怨, 뙏 媛뒾 븵뿉 X옄濡 援먯감떆耳 諛섎履 뼱源 쐞뿉 넀쓣 넃 떎쓬 紐명넻쓣 醫뚯슦濡 媛곴컖 쉶쟾븯寃 빐꽌 痢≪젙븯떎20. 愿젅 媛곷룄怨꾨 1–2踰 쓨異붿쓽 洹밸룎湲 궗씠뿉 0°濡 怨좎젙븯怨 媛곴컖 醫뚯슦濡 利앹긽씠 엳뒗 뼱源 履 諛⑺뼢怨 利앹긽씠 뾾뒗 履 諛⑺뼢쓽 쓨異 쉶쟾 媛곷룄瑜 痢≪젙븯떎(Fig. 3).

Fig. 2. Measurement of thoracic spine extension mobility. (A) Posture for measurement of thoracic spine extension mobility. (B) Vertebral centroid angle (arrow).
Fig. 3. Measurement of thoracic spine rotation mobility. (A) Posture for measurement of thoracic spine rotation mobility. (B) Measuring angle in reference to the line connecting both acromions (dotted line) using a goniometer (solid line).

4) 寃ш젅 湲곕뒫 젏닔(shoulder function score)

寃ш젅쓽 湲곕뒫 룊媛뒗 씪긽깮솢쓽 遺덊렪媛 젙룄 諛 洹쇰젰 긽깭, 寃ш젅 媛룞踰붿쐞, 넻利 젙룄瑜 븣븘蹂 닔 엳뒗 American Shoulder and Elbow Surgeons Shoulder Score (ASES) Constant score瑜 궗슜븯떎. 몢 꽕臾몄뒗 留롮 꽑뻾 뿰援ъ뿉꽌 떊猶곕룄 떦룄媛 寃利앸릺뿀쑝硫, 옱쁽꽦씠 넂怨 엫긽뿉꽌 돺寃 쟻슜븷 닔 엳뼱 嫄곗쓽 紐⑤뱺 뼱源 吏덊솚뿉 궗슜븷 닔 엳떎뒗 옣젏씠 엳떎. 꽑뻾 뿰援ъ뿉꽌 솗씤맂 몢 꽕臾몄쓽 떊猶곕룄(intraclass correlation coefficient [ICC]) 엫긽쟻쑝濡 以묒슂븳 理쒖냼 李⑥씠(minimum clinically important difference [MCDI])뒗 媛곴컖 ASES뿉꽌 ICC媛 0.84–0.96, MCDI媛 10.4젏, Constant score뿉꽌 ICC媛 0.8–0.87, MCDI뒗 12–17젏쑝濡 굹궗떎21,22.

5) 寃ш젅 벑냽꽦 洹쇰젰(isokinetic muscle strength of shoulder)

寃ш젅쓽 벑냽꽦 洹쇰젰 寃궗뒗 HUMAC NORM (CSMi, Stoughton, MA, USA)쓣 궗슜븯뿬 뼱源⑥쓽 쇅쉶쟾, 궡쉶쟾, 쇅쟾, 궡쟾 寃궗瑜 떎떆븯쑝硫 異⑸텇븳 寃궗 꽕紐낃낵 以鍮꾩슫룞쓣 떎떆븳 썑뿉 痢≪젙븯떎. 媛 寃궗뒗 60°/珥덉쓽 媛곸냽룄濡 4쉶뵫 痢≪젙븯쑝硫, 솚痢≪쓽 理쒕 슦젰(peak torque)쓣 痢≪젙븳 썑 궗濡쒓렇옩떦 돱꽩 誘명꽣(newton meters per kilogram) 떒쐞쓽 泥댁쨷떦 理쒕 슦젰(peak torque per body weight)쑝濡 젙洹쒗솕븯뿬 援 궡 援 媛꾩쓽 쟾썑 李⑥씠瑜 룊媛븯떎23.

6) 寃ш컩怨 쐞移(scapular position)

寃ш컩怨⑥쓽 쐞移섎뒗 Park 벑24쓽 꽑뻾뿰援ъ뿉꽌 넂 룊媛옄 媛 떊猶곕룄媛 寃利앸맂 3李⑥썝 寃ш컩怨 쟾궛솕떒痢듭눋쁺(3-dimensional wing computer tomography, 3D wing CT)쓣 넻븳 寃ш컩怨 쐞移 룊媛 諛⑸쾿쓣 궗슜븯뿬 痢≪젙븯떎. 珥ъ쁺 諛⑹궗꽑웾쑝濡 꽕젙맂 64-slice 떎以묎異쒓린 쟾궛솕떒痢듭눋쁺(multidetector computer tomography) 뒪罹먮꼫(Aquilion Model TSX-101A; Toshiba Medical Systems Corp., Otawara, Japan)瑜 궗슜븯뿬 떎떆븯떎. 솚옄瑜 븰쐞(supine position)濡 닏寃 븯뿬 뼇痢 뙏쓣 媛吏윴엳 紐명넻 쁿뿉 넃 긽깭뿉꽌 珥ъ쁺븳 3D wing CT 씠誘몄瑜 PACS m-view 5.4瑜 궗슜빐 寃ш컩怨⑥쓽 긽諛⑺쉶쟾(upward rotation), 궡쉶쟾(internal rotation), 쟾諛⑷꼍궗(anterior tilting), 긽諛⑹쟾쐞(superior translation), 쟾씤(protraction) 媛곷룄瑜 痢≪젙븯떎(Fig. 4).

Fig. 4. Scapular position analyzed by 3-dimensional wing computer tomography. (A) Upward rotation (UR). (B) Internal rotation (IR). (C) Anterior tilting (AT). (D) Superior translation (ST). (E) Protraction (PRO).

4. 옄猷 泥섎━

蹂 뿰援ъ뿉꽌 뼸뼱吏 紐⑤뱺 옄猷뚮뱾 IBM SPSS version 22.0 (IBM Corp., Armonk, NY, USA) 봽濡쒓렇옩쓣 씠슜븯뿬 湲곗닠 넻怨꾩튂(mean, 몴以렪李)瑜 궛異쒗븯떎. 寃ш젅 넻利, ROM, 湲곕뒫, 벑냽꽦 洹쇰젰쓽 떆湲곗뿉 뵲瑜 蹂솕 援 媛 李⑥씠쓽 긽샇옉슜쓣 룊媛븯湲 쐞빐 씠썝 諛섎났痢≪젙 遺꾩궛遺꾩꽍(two-way repeated measure analysis of variance)쓣 떎떆븯쑝硫, 쑀쓽븳 긽샇옉슜 슚怨쇨 굹궃 蹂씤뿉 빐꽌뒗 援곕퀎 슫룞 쟾썑쓽 李⑥씠 떆湲곕퀎 援 媛꾩쓽 李⑥씠뿉 븳 鍮꾧탳瑜 넻빐 궗썑 寃젙쓣 떎떆븯떎. 슫룞 쟾썑 寃ш컩怨 쐞移 蹂솕쓽 李⑥씠뿉 븳 쑀쓽꽦 CE援 궡뿉꽌 쓳몴蹂 t-寃젙(paired t-test)쓣 떎떆븯뿬 룊媛븯떎. 紐⑤뱺 寃곌낵쓽 넻怨꾩쟻 쑀쓽 닔以 ?=0.05濡 꽕젙븯떎.

寃 怨

1. 뿰援 긽옄쓽 듅꽦

蹂 뿰援ъ뿉 룷븿맂 긽옄 20紐낆쓣 CE援(n=10)怨 SE援(n=10)쑝濡 媛곴컖 臾댁옉쐞 遺꾨쪟븯떎. 긽옄뱾쓽 뿰졊, 꽦蹂, 떊옣, 泥댁쨷, 泥댁쭏웾吏닔, 怨④꺽洹쇰웾, 泥댁諛⑸웾, 泥댁諛⑸쪧怨 媛숈 씤援ы넻怨꾪븰쟻 듅꽦뿉꽌뒗 援 媛꾩뿉 넻怨꾩쟻쑝濡 쑀쓽븳 李⑥씠媛 뾾뿀떎(Table 2).

Table 2 . Characteristics of subjects

CharacteristicCE groupSE groupp-value
No. of patients1010
Age (yr)49.50±4.8648.60±6.550.731
Sex (male:female)5:56:40.653
Height (cm)168.80±7.77165.50±9.170.397
Weight (kg)61.31±8.5565.09±7.450.306
BMI (kg/m2)21.49±2.5223.82±2.670.060
SMM (kg)25.27±5.2427.90±6.680.340
%BF (%)24.90±7.2023.25±10.700.691

Values are presented as number or mean±standard deviation.

CE: combination exercise, SE: shoulder exercise, %BF: percent body fat, BMI: body mass index, SMM: skeletal muscle mass.



2. 寃ш젅 넻利앹뿉 븳 쓨異붽룞꽦 슫룞쓽 슚怨

寃ш젅 넻利앹쓽 슫룞 쟾·썑 蹂솕 援 媛꾩쓽 李⑥씠뿉뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 엳뒗 寃껋쑝濡 굹궗떎(p<0.05). 몢 援 紐⑤몢 12二 슫룞 썑뿉 슫룞 쟾蹂대떎 넻利 젏닔媛 쑀쓽븯寃 媛먯냼븯쑝굹(p<0.05), 援 媛 鍮꾧탳뿉꽌 CE援(–67.14%)씠 SE援(–54.07%)蹂대떎 뜑 留롮 媛먯냼瑜 蹂댁떎(p<0.05) (Table 3).

Table 3 . Shoulder pain

GroupVAS scoreSourceF-valuep-value

PreexercisePostexerciseΔ%
CE7.79±0.622.56±0.54−67.14Group×time5.1110.036*
SE7.62±0.693.50±0.88−54.07Time362.6320.001*
Group4.1040.058

Values are presented as mean±standard deviation unless otherwise specified.

VAS: visual analogue scale, CE: combination exercise, SE: shoulder exercise.

Δ%=[(postexercise–preexercise)/preexercise]×100.

*p<0.05, statistically significant; p<0.05, significantly different from SE group.



3. 寃ш젅 愿젅 媛룞 踰붿쐞뿉 븳 쓨異붽룞꽦 슫룞쓽 슚怨

寃ш젅 ROM뿉꽌 슫룞 쟾썑 궡쉶쟾, 쇅쉶쟾, 援닿끝, 쇅쟾 媛곷룄쓽 蹂솕 援 媛꾩쓽 李⑥씠뿉뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹굹吏 븡븯떎. 몢 援 紐⑤몢 12二 슫룞 썑뿉 슫룞 쟾蹂대떎 궡쉶쟾, 쇅쉶쟾, 援닿끝, 쇅쟾 媛곷룄媛 쑀쓽븯寃 利앷븯쑝굹(p<0.05), 援 媛 鍮꾧탳뿉꽌뒗 쇅쉶쟾怨 援닿끝뿉꽌留 CE援곗뿉꽌 쑀쓽븳 利앷媛 엳뿀怨(p<0.05), 궡쉶쟾怨 쇅쟾뿉꽌뒗 쑀쓽븳 李⑥씠媛 뾾뿀떎(Table 4).

Table 4 . Shoulder range of motion

VariableGroupPreexercisePostexerciseΔ%SourceF-valuep-value
Internal rotation (°)CE42.50±5.4061.50±4.1244.71Group×time0.4350.518
SE47.00±8.5663.50±5.8035.11Time
Group
87.754
2.600
0.001*
0.124
External rotation (°)CE50.00±8.8282.50±8.9065.00Group×time3.9260.063
SE49.40±7.4973.50±4.7448.79Time
Group
178.262
3.164
0.001*
0.092
Flexion (°)CE145.50±9.26176.50±4.1221.31Group×time0.6860.418
SE142.00±11.60169.00±5.1619.01Time
Group
144.171
4.109
0.001*
0.058
Abduction (°)CE141.00±25.91173.00±4.2222.70Group×time0.0490.827
SE144.50±10.92174.50±7.9820.76Time
Group
47.327
0.268
0.001*
0.611

Values are presented as mean±standard deviation unless otherwise specified.

CE: combination exercise, SE: shoulder exercise.

Δ%=[(postexercise–preexercise)/preexercise]×100.

*p<0.05, statistically significant; p<0.05, significantly different from SE group.



4. 쓨異붽룞꽦뿉 븳 쓨異붽룞꽦 슫룞쓽 슚怨

쓨異붽룞꽦뿉꽌 슫룞 쟾썑 쓨異 떊쟾 諛 利앹긽 痢, 鍮꾩쬆긽 痢 쉶쟾 媛곷룄쓽 蹂솕 援 媛꾩쓽 李⑥씠뿉뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹궗떎(p<0.05). CE援곗뿉꽌留 12二 슫룞 썑뿉 슫룞 쟾蹂대떎 쓨異 떊쟾 諛 利앹긽 痢, 鍮꾩쬆긽 痢 쉶쟾 媛곷룄媛 쑀쓽븯寃 利앷븯쑝硫(p<0.05), 援 媛 鍮꾧탳뿉꽌룄 쑀쓽븳 李⑥씠媛 엳뿀떎(p<0.05) (Table 5).

Table 5 . Thoracic spine mobility

VariableGroupPreexercisePostexerciseΔ%SourceF-valuep-value
Extension (°)CE17.94±0.9313.16±1.03−26.64Group×time159.7640.001*
SE17.11±0.8317.04±0.82−0.41Time
Group
169.403
17.834
0.001*
0.001*
SD rotation (°)CE34.82±4.8341.48±5.5719.13Group×time42.0220.001*
SE36.52±1.4636.45±1.31−0.19Time
Group
40.292
1.048
0.001*
0.319*
NSD rotation (°)CE43.09±2.6044.16±2.592.48Group×time13.7250.002*
SE42.24±3.4842.45±3.630.50Time
Group
30.403
0.851
0.001*
0.368

Values are presented as mean±standard deviation unless otherwise specified.

CE: combination exercise, SE: shoulder exercise, SD; symptomatic direction, NSD: non-symptomatic direction.

Δ%=[(postexercise–preexercise)/preexercise]×100.

*p<0.05, statistically significant; p<0.05, significantly different from SE group.



5. 寃ш젅 湲곕뒫 젏닔뿉 븳 쓨異붽룞꽦 슫룞쓽 슚怨

寃ш젅 湲곕뒫 젏닔뿉꽌 슫룞 쟾썑 ASES쓽 蹂솕 援 媛꾩쓽 李⑥씠뿉뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹궗쑝굹(p<0.05), Constant score뿉꽌뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹굹吏 븡븯떎. 몢 援 紐⑤몢 12二 슫룞 썑뿉 슫룞 쟾蹂대떎 ASES Constant score媛 쑀쓽븯寃 利앷븯쑝굹(p<0.05), 援 媛 鍮꾧탳뿉꽌 ASES뒗 CE援(52.03%)씠 SE援(35.02%)蹂대떎 뜑 留롮 利앷瑜 蹂댁씤 諛섎㈃(p<0.05), Constant score뿉꽌뒗 쑀쓽븳 李⑥씠媛 뾾뿀떎(Table 6).

Table 6 . Shoulder function score

VariableGroupPreexercisePostexerciseΔ%SourceF-valuep-value
ASESCE61.70±8.0393.80±1.5552.03Group×time10.2990.005*
SE63.40±4.6785.60±3.2035.02Time309.8240.001*
Group4.1130.058
Constant scoreCE52.80±4.1387.90±4.5666.48Group×time1.8980.185
SE53.10±10.7182.80±3.9455.93Time273.2560.001*
Group1.2620.276

Values are presented as mean±standard deviation unless otherwise specified.

ASES: American Shoulder and Elbow Surgeons Score, CE: combination exercise, SE: shoulder exercise.

Δ%=[(postexercise–preexercise)/preexercise]×100.

*p<0.05, statistically significant; p<0.05, significantly different from SE group.



6. 寃ш젅 벑냽꽦 洹쇰젰뿉 븳 쓨異붽룞꽦 슫룞쓽 슚怨

寃ш젅 벑냽꽦 洹쇰젰뿉꽌 슫룞 쟾썑 쇅쉶쟾, 쇅쟾 洹쇰젰쓽 蹂솕 援 媛꾩쓽 李⑥씠뿉뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹궗쑝굹(p<0.05), 궡쉶쟾, 궡쟾 洹쇰젰뿉꽌뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹굹吏 븡븯떎. 몢 援 紐⑤몢 12二 슫룞 썑뿉 슫룞 쟾蹂대떎 쇅쉶쟾, 궡쉶쟾, 쇅쟾, 궡쟾 洹쇰젰씠 쑀쓽븯寃 利앷븯쑝굹(p<0.05), 援 媛 鍮꾧탳뿉꽌 쇅쉶쟾, 쇅쟾 洹쇰젰 CE援(103.43%, 64.85%)씠 SE援(50.13%, 20.86%)蹂대떎 뜑 겙 利앷瑜 蹂댁씤 諛섎㈃(p<0.05), 궡쉶쟾, 궡쟾 洹쇰젰뿉꽌뒗 쑀쓽븳 李⑥씠媛 뾾뿀떎(Table 7).

Table 7 . Isokinetic muscle strength of shoulder

VariableGroupPreexercisePostexerciseΔ%SourceF-valuep-value
External rotation (Nm)CE12.26±2.4424.94±3.52103.43Group×time18.4100.001*
SE11.45±1.1217.19±1.1250.13Time129.6890.001*
Group47.2450.001*
Internal rotation (Nm)CE21.70±2.5931.59±2.0445.58Group×time0.0020.964
SE22.60±3.0632.54±3.5143.98Time326.0810.001*
Group0.6440.433
Abduction (Nm)CE21.82±1.5035.97±2.7464.85Group×time91.3000.001*
SE23.15±2.7427.98±2.9320.86Time378.6420.001*
Group10.4900.005*
Adduction (Nm)CE52.91±5.6267.90±4.7228.33Group×time0.0010.974
SE53.73±4.6168.83±6.0028.10Time80.7900.001*
Group0.2780.604

Values are presented as mean±standard deviation unless otherwise specified.

CE: combination exercise, SE: shoulder exercise.

Δ%=[(postexercise–preexercise)/preexercise]×100.

*p<0.05, statistically significant; p<0.05, significantly different from SE group.



7. 寃ш컩怨 쐞移 蹂솕뿉 븳 쓨異붽룞꽦 슫룞쓽 슚怨

CE援 궡뿉꽌 슫룞 쟾썑 寃ш컩怨 쐞移 蹂솕瑜 鍮꾧탳븳 寃곌낵 寃ш컩怨⑥쓽 긽諛⑺쉶쟾怨 긽諛⑹쟾쐞 媛곷룄뒗 궗쟾·궗썑 寃궗 媛꾩뿉 넻怨꾩쟻쑝濡 쑀쓽븳 李⑥씠媛 뾾뿀쑝굹, 寃ш컩怨⑥쓽 궡쉶쟾, 쟾諛⑷꼍궗, 쟾씤 媛곷룄뒗 12二 썑쓽 寃궗뿉꽌 넻怨꾩쟻쑝濡 쑀쓽븯寃 媛먯냼븯떎(p<0.05) (Table 8).

Table 8 . Scapular position in the combination exercise group

VariableTimeMean±SDtp-value
Upward rotation (°)Preexercise111.22±5.69−0.7240.488
Postexercise111.96±4.16
Internal rotation (°)Preexercise53.24±3.149.2930.001*
Postexercise44.39±2.16
Anterior tilting (°)Preexercise8.99±2.1311.8230.001*
Postexercise2.38±0.53
Superior translation (°)Preexercise91.45±1.631.0230.333
Postexercise91.38±1.59
Protraction (°)Preexercise105.98±2.2913.7770.001*
Postexercise94.85±2.42

SD: standard deviation.

*p<0.05, statistically significant.


怨 李

寃ш젅쓽 넻利앷낵 寃쎌쭅, 빟솕뒗 寃щ큺븯 異⑸룎利앺썑援 솚옄뱾뿉꽌 鍮덈쾲븯寃 諛쒖깮븯뒗 몴쟻씤 利앹긽뱾씠硫 닔硫 옣븷 諛 솢룞 媛먯냼瑜 珥덈옒븯怨, 궣쓽 吏덉쓣 븯떆궓떎25. 뿬윭 슂씤뱾 以 쓨異붿쓽 젣븳맂 媛룞꽦 寃ш컩怨⑥쓽 쐞移섏 吏곸엫쓣 遺쟻젅븯寃 留뚮뱾뼱 異⑸룎利앺썑援곗쓣 쑀諛쒗븯嫄곕굹 븙솕떆궗 닔 엳쑝硫26,27, 쓨異붿쓽 媛룞꽦 利앷媛 異⑸룎利앺썑援 솚옄뱾쓽 넻利 媛먯냼 諛 湲곕뒫 媛쒖꽑뿉 쑀쓽븳 쁺뼢쓣 誘몄튂뒗 寃껋쑝濡 蹂닿퀬릺뿀떎6-8. 븯吏留 씠쟾쓽 뿰援щ뱾 遺遺 寃ш젅뿉 븳 移섎즺쟻 슫룞怨 蹂묓뻾븯뿬 쓨異붿쓽 媛룞꽦 利앷瑜 쐞븳 以묒옱濡쒖꽌 룄닔移섎즺쓽 슚怨쇱뿉 珥덉젏쓣 留욎텛怨 엳쑝硫, 쓨異붽룞꽦 슫룞쓽 슚怨쇰 떎猷 뿰援щ뒗 遺議깊븳 떎젙씠떎. 蹂 뿰援ъ뿉꽌뒗 12二쇨컙 寃ш젅 슫룞 봽濡쒓렇옩怨 蹂묓뻾븯뿬 떎떆븳 쓨異붽룞꽦 슫룞씠 寃щ큺븯 異⑸룎利앺썑援 솚옄쓽 寃ш젅 넻利, ROM, 湲곕뒫, 벑냽꽦 洹쇰젰 쉶蹂 諛 寃ш컩怨 쐞移 蹂솕뿉 誘몄튂뒗 쁺뼢쓣 遺꾩꽍븯쑝硫, 뿰援 寃곌낵뿉 뵲瑜 끉쓽뒗 떎쓬怨 媛숇떎.

VAS뒗 씪긽깮솢 솢룞 諛 슫룞쓣 떎떆븯뒗 룞븞 뒓겮뒗 二쇨쟻씤 넻利앹쓽 젙룄瑜 떆媛곸쟻쑝濡 몴떆븿쑝濡쒖뜥 넻利 蹂솕瑜 媛꾨떒븯寃 諛섏쁺븷 닔 엳뒗 룊媛 룄援ъ씠떎17. 寃ш젅 넻利앹뿉꽌뒗 몢 援 紐⑤몢 12二 썑뿉 VAS 젏닔媛 쑀쓽븯寃 媛먯냼븯吏留, CE援곗뿉꽌 뜑 留롮 넻利 媛먯냼瑜 蹂댁씠硫 쑀쓽븳 긽샇옉슜 슚怨쇨 굹궗떎. 씠윭븳 긽샇옉슜 쓨異 룄닔移섎즺 썑 異⑸룎利앺썑援 솚옄뱾쓽 寃ш젅 넻利 諛 利앹긽씠 쑀쓽븯寃 媛쒖꽑릱떎怨 蹂닿퀬븳 꽑뻾뿰援ъ쓽 寃곌낵 쑀궗븯硫28, 쓨異붽룞꽦 슫룞 삉븳 룄닔移섎즺 留덉갔媛吏濡 寃ш젅 넻利 媛먯냼뿉 쑀쓽븳 쁺뼢쓣 誘몄튂뒗 寃껋쑝濡 깮媛곷맂떎.

寃ш젅쓽 ROM뒗 몢 援 紐⑤몢 궡쉶쟾, 쇅쉶쟾, 援닿끝, 쇅쟾씠 12二 썑뿉 쑀쓽븯寃 利앷븯吏留, 슫룞 쟾썑 蹂솕 援 媛꾩쓽 李⑥씠뿉뒗 쑀쓽븳 긽샇옉슜 슚怨쇨 굹굹吏 븡븯떎. 씠윭븳 寃곌낵뒗 寃ш컩怨 吏곸엫怨 蹂듯빀쟻쑝濡 諛쒖깮븯뒗 寃ш젅쓽 깮泥댁뿭븰쟻 뒫룞 吏곸엫(biomechanical active movement)뿉뒗 쓨異붿쓽 떊쟾 媛룞꽦씠 쑀쓽븳 쁺뼢쓣 誘몄튂吏留18,27, 븞젙 떆 옄꽭(resting posture)뿉꽌 씪뼱굹뒗 寃ш젅쓽 怨좊┰맂 吏곸엫(isolated movement)뿉뒗 吏곸젒쟻씤 寃ш젅 ROM 슫룞쓽 쁺뼢씠 뜑 겕寃 옉슜븯湲 븣臾몄씤 寃껋쑝濡 깮媛곷맂떎.

쓨異붽룞꽦 CE援곗뿉꽌留 12二 썑뿉 쓨異 떊쟾 諛 利앹긽 痢, 鍮꾩쬆긽 痢 쉶쟾씠 쑀쓽븯寃 利앷븯쑝硫, 슫룞 쟾·썑 蹂솕 援 媛꾩쓽 李⑥씠뿉룄 쑀쓽븳 긽샇옉슜 슚怨쇨 굹궗떎. 씠뒗 Strunce 벑28씠 꽑뻾뿰援ъ뿉꽌 뼱源 넻利앹쓣 샇냼븯뒗 솚옄뱾뿉꽌 쓨異붿뿉 븳 룄닔移섎즺 以묒옱媛 쓨異붽룞꽦 利앷 븿猿 寃ш젅 넻利앹쓣 媛쒖꽑떆耳곕떎怨 蹂닿퀬븳 寃곌낵 쑀궗븯떎. 솚옄媛 뒪뒪濡 닔뻾븯뒗 뒫룞쟻씤 쓨異붽룞꽦 슫룞 삉븳 移섎즺궗뿉 쓽븳 닔룞쟻씤 룄닔移섎즺 留덉갔媛吏濡 쓨異붿쓽 媛룞꽦 利앷뿉 슚怨쇨 엳뒗 寃껋쑝濡 깮媛곷맂떎.

씪긽깮솢怨 愿젴맂 寃ш젅 湲곕뒫 젏닔뒗 몢 援 紐⑤몢 12二 썑뿉 ASES Constant score媛 쑀쓽븯寃 利앷븯쑝굹 슫룞 쟾썑 蹂솕 援 媛꾩쓽 李⑥씠뿉꽌 쑀쓽븳 긽샇옉슜 슚怨쇰뒗 ASES뿉꽌留 굹궗떎. 씠뒗 넻利앹뿉 븳 諛곗젏 鍮꾩쑉씠 50%瑜 李⑥븯뒗 ASES 鍮꾧탳뻽쓣 븣 Constant score뒗 넻利앹뿉 븳 諛곗젏 鍮꾩쑉 15%씤 諛섎㈃ 寃ш젅 ROM怨 愿젴맂 諛곗젏 鍮꾩쑉씠 40%濡 넂湲 븣臾몄뿉21,22 寃ш젅 ROM뿉 븳 寃곌낵뿉꽌 쑀쓽븳 긽샇옉슜 슚怨쇨 굹굹吏 븡븯뜕 寃껉낵 媛숈 留λ씫쑝濡 깮媛곷맂떎. ASES뿉꽌 CE援곗뿉 뜑 겙 슚怨쇨 굹궃 씠쑀뒗 異붽쟻씤 쓨異붽룞꽦 슫룞쑝濡 쓨異붿쓽 媛룞꽦씠 利앷븯硫댁꽌 寃ш컩怨④낵 긽셿怨 媛꾩쓽 룞쟻씤 吏곸엫씠 媛쒖꽑릺뼱 넻利, 洹쇰젰, 궣쓽 留뚯”룄 벑쓽 二쇨쟻씤 씪긽깮솢솢룞 닔以씠 뼢긽릱湲 븣臾몄쑝濡 깮媛곷맂떎.

寃ш젅 벑냽꽦 洹쇰젰 몢 援 紐⑤몢 12二 썑뿉 슫룞 쟾蹂대떎 쇅쉶쟾, 궡쉶쟾, 쇅쟾, 궡쟾 洹쇰젰씠 쑀쓽븯寃 利앷븯吏留, 슫룞 쟾썑 蹂솕 援 媛꾩쓽 李⑥씠뿉꽌 쑀쓽븳 긽샇옉슜 슚怨쇰뒗 쇅쉶쟾, 쇅쟾쓽 理쒕 슦젰뿉꽌留 굹궗떎. CE援곗뿉꽌 12二 썑뿉 쇅쉶쟾, 쇅쟾 벑냽꽦 洹쇰젰씠 뜑 겕寃 利앷븳 씠쑀뒗 McCreesh 벑29씠 쓨異붿쓽 썑留뚯쑝濡 쑀諛쒕맂 寃ш컩怨⑥쓽 遺쟻젅븳 쐞移섎줈 寃щ큺븯 怨듦컙씠 醫곸븘졇 寃ш젅쓽 쇅쟾怨 쇅쉶쟾뿉 愿뿬븯뒗 洹뱀긽洹쇱쓽 嫄댁뿉 븬젰怨 異⑸룎쓣 쑀諛쒗븯怨 寃ш젅 넻利앹쓣 룞諛섑븳 洹쇰젰 빟솕濡 씠뼱吏꾨떎怨 蹂닿퀬븳 諛붾줈 蹂댁븯쓣 븣, 쓨異붽룞꽦 슫룞쓣 떎떆븳 援곗뿉꽌뒗 寃ш컩怨⑥쓽 쐞移섏 吏곸엫씠 媛쒖꽑릺뼱 쉶쟾洹쇨컻 嫄댁뿉 媛빐吏뜕 븬젰怨 異⑸룎씠 媛먯냼븯硫댁꽌 쇅쉶쟾, 쇅쟾 벑냽꽦 洹쇰젰뿉꽌 뜑 겙 슚怨쇨 굹궃 寃껋쑝濡 깮媛곷맂떎.

寃ш컩怨 쐞移섎뒗 CE援 궡뿉꽌 쓨異붽룞꽦 슫룞 쟾썑 떆湲 媛꾩쓽 蹂솕瑜 鍮꾧탳븯떎. 12二 썑뿉 寃ш컩怨⑥쓽 긽諛⑺쉶쟾, 긽諛⑹쟾쐞 媛곷룄뿉꽌뒗 쑀쓽븳 李⑥씠媛 굹굹吏 븡븯吏留, 궡쉶쟾, 쟾諛⑷꼍궗, 쟾씤 媛곷룄뿉꽌뒗 넻怨꾩쟻쑝濡 쑀쓽븳 李⑥씠媛 굹궗떎.

寃ш컩怨⑥쓽 궡쉶쟾, 쟾諛⑷꼍궗, 쟾씤뿉꽌留 쑀쓽븳 쐞移 蹂솕媛 굹궃 씠쑀뒗 寃ш컩怨⑥쓽 긽諛⑺쉶쟾怨 긽諛⑹쟾쐞媛 쓨異붿쓽 젙젹怨 媛룞꽦蹂대떎뒗 寃ш컩怨 옄泥 吏곸엫뿉 愿뿬븯뒗 寃ш컩怨 긽諛⑺쉶쟾洹(upward rotator muscles)쓽 쁺뼢쓣 뜑 留롮씠 諛쏄린 븣臾몄쑝濡 깮媛곷맂떎30. 뵲씪꽌 寃щ큺븯 異⑸룎利앺썑援 솚옄쓽 옱솢 슫룞 봽濡쒓렇옩 怨꾪쉷 떆 寃ш컩怨⑥쓽 븯諛⑺쉶쟾, 긽諛⑹쟾쐞媛 愿李곕릺뒗 寃쎌슦뿉뒗 寃ш컩怨⑥쓽 二쇱슂 긽諛⑺쉶쟾洹쇱씤 긽遺·븯遺 듅紐④렐(upper and lower trapezius muscle)怨 쟾嫄곌렐(serratus anterior)뿉 븳 슫룞쓣 뜑슧 媛뺤“빐빞 븷 寃껋쑝濡 깮媛곷맂떎. Sahrmann12쓽 꽑뻾 뿰援ъ뿉꽌 寃ш컩怨⑥쓽 쟾씤, 븯諛⑺쉶쟾, 궡쉶쟾, 쟾諛⑷꼍궗쓽 利앷媛 寃ш젅쓽 넻利앹쓣 쑀諛쒗븯뒗 슂씤씠씪怨 蹂닿퀬븳 諛붾줈 蹂댁븯쓣 븣 12二쇨컙쓽 쓨異붽룞꽦 슫룞씠 寃ш컩怨⑥쓽 쐞移섏뿉 湲띿젙쟻씤 蹂솕瑜 媛졇삩 寃껋쑝濡 뙋떒맂떎. 洹몃윭굹 蹂 뿰援ъ뿉꽌뒗 쓨異붽룞꽦 슫룞쓣 떎떆븳 援 궡뿉꽌留 떆湲 媛 寃ш컩怨 쐞移 蹂솕瑜 솗씤뻽떎뒗 젣븳젏씠 엳쑝誘濡 異뷀썑 쓨異붽룞꽦 슫룞쓣 떎떆븯吏 븡 議곌뎔怨쇱쓽 援 媛 李⑥씠瑜 鍮꾧탳븯뒗 썑냽 뿰援ш 븘슂븷 寃껋쑝濡 깮媛곷맂떎. 삉븳 젙쟻씤 옄꽭뿉꽌 寃ш컩怨 쐞移섎 룊媛븯뒗 3D wing CT 룊媛 諛⑸쾿쓽 궡옱쟻 븳怨꾨줈 씤빐 룞쟻씤 寃ш컩怨 슫룞 쟻젅븯寃 諛섏쁺릺吏 紐삵뻽쓣 닔 엳떎. 蹂 뿰援ъ뿉꽌뒗 씠윭븳 븳怨꾨 洹밸났븯湲 쐞빐 寃ш컩怨 二쇰 洹쇱쑁(periscapular muscle)쓣 씠셿떆궓 옄꽭뿉꽌 븞젙 떆 寃ш컩怨 쐞移섏쓽 蹂솕瑜 理쒕븳 젙솗븯寃 痢≪젙븯湲 쐞빐 끂젰븯떎.

寃곕줎쟻쑝濡 寃щ큺븯 異⑸룎利앺썑援 솚옄뱾뿉꽌 떒씪 寃ш젅 슫룞留 떎떆뻽쓣 븣蹂대떎 쓨異붽룞꽦 슫룞쓣 蹂듯빀 떎떆븯쓣 븣 寃ш젅 넻利, 벑냽꽦 洹쇰젰, 씪긽깮솢湲곕뒫 諛 寃ш컩怨 쐞移 蹂솕뿉 湲띿젙쟻씤 쁺뼢쓣 誘몄튇떎뒗 寃껋쓣 솗씤븯떎. 蹂 뿰援ъ쓽 寃곌낵瑜 넗濡 寃щ큺븯 異⑸룎利앺썑援 솚옄瑜 쐞븳 슫룞 봽濡쒓렇옩쓣 怨꾪쉷븷 븣 寃ш젅 슫룞怨 쓨異붽룞꽦 슫룞쓣 븿猿 議고빀븯뿬 쟻슜떆궓떎硫 寃ш젅쓽 넻利 셿솕 諛 湲곕뒫 뼢긽뿉 뜑슧 슚怨쇱쟻씤 以묒옱 諛⑸쾿씠 맆 寃껋쑝濡 깮媛곹븳떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization: MYC, SHJ. Data curation: JSK. Methodology: DHK. Project administration: SHJ. Writing–original draft: MYC. Writing–review & editing: All authors.

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