경견완부 통증 치료

2015년 11월 29일 에스엠씨33의원

김강호

명품 Bag(X) Back(O)

• 뒷목통증 • 어깨쭉지 통증 • 견갑골 사이 통증 • 견갑골/어깨 후면 통증

• 뒷목과 어깨가 항상 뭉친다 • 잠을 잘 못 잔것 같다

Related Structure

• Cervical/thoracic vertebra • Ribs • Scapula • Trapezius • Rhomboideus minor/major • Levator scapula • infraspinatus

Case 1

• 20세 여자

• 후경부와 견갑골 내측 통증

• 목의 움직임(굴곡, 신전, 회전, 측굴)시 통증

• 2일전 새벽, 응급실 진료

Case 2

• 27세 남자

• 견갑골 사이, 우측, 뻐근한 통증

• 움직임과 무관

• 1년 정도, 기타 치료에 반응 없었음

• Originates in the 5th cervical n. root • Pierces the scalen medius • Pass posteriorly beneath the l. scapulae

• DSN innervates the l.scapulae, rhomboid

major, minor muscles

DSN syndrome

• Scapula medial border pain

• Shoulder pain

• Shoulder dysfunction

• Thoracic outlet syndrome

- Pectoralis minor syndrome type

DSN syndrome

• Scalene muscle trauma

• Whiplash injury

• Usually scalene medius muscle

• Overhead work position

- painters, electricians etc.

DSN syndrome

• Motor nerve entrapment

• Sensory nerve entrapment

• Both

DSN syndrome

• Myofacial release technique • Post isometric relaxation - a form of Muscle Energy Technique • Proprioceptive neuromuscular

facilitation • Strain – counter strain technique

Diagnosis and Treatment of Pain of Vertebral origin (Cervical point of Back) - Robert Maigne-

Cervical point of Back

• R. Maigne - 1964 • Specific tender point or zone - T4 spinous pr.(T5 body) • Thickened skin and pinch & roll

hypersensitivity • Palpation of the cervical spine reveals

tenderness(C5-6, C6-7) • Cervical manipulation symptom

relieve instantly

Connection

• T2 dorsal cutaneous branch innervate

broad area of skin

• C4 & T2 dermatomes are neighbors

• C5~T1 dermatome are drawn out into

upper limbs

• So C5~T1 have no dorsal dermatome

Relation between T2 and the Cervical point of Back

Maigne 家의 반론

• Jean-Yves Maigne -2002- • Interscapular point는 splenius cervicis

muscle의 하부 부착부와 연관 – 가설 • 53명의 환자를 대상으로 연구 • 17구의 cadavers study

• Origin – T3~T6 spinous

process

• Insertion – C1,2 transverse

process

• Innervation – C5~C7 dorsal ramus

Splenus cervicis muscle

Treatment

• Manipulation – Rotation, extension, lateral flexion

• Anti-inflammatory treatment

• Physiotherapy

• R. maigne - facet injection

Levator scapular syndrome

• Embryologically same splenius cervicis

• C4~6 dorsal ramus

• Same treatment of the splenius cervicis syndrome

Case 1

• 움직임에 의해 통증 유발 • Cervical manipulation 불가 • Scalene medius injection • Levator scapular injection

• PT 후 증상 호전

Case 2

• Scalene medius injection – 30%정도 호전있으나 여전히 불편

• Pinch and roll – T2~T5, 승모근 부위의 통증

• FFST type II • C4,5,6,7 facet area tenderness

injection • 일주일 간격 4회 치료로 90%이상 호전

Reference

• Dorsal scapular nerve entrapment syndrome – Hans Boehnke

• Diagnosis and Treatment of pain of Vertebral Origin – Robert Maigne

• Splenius cervicis syndrome – Jean Yves Maigne

• 통증의 원리와 성찰 – 성정원 • THIEME, Atlas of Anatomy

Thank you for your attension!