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Manguito Rotador: Tratamiento Kinesiológico

Comentarios39 | 05 Febrero, 2014 | Por Dr. Michael Marsalli

Manguito Rotador Tratamiento Kinesiológico es una nota que presenta una pauta de manejo kinesiológico de la tendinopatía del manguito rotador para los casos en que se opte por el tratamiento no quirúrgico, según la mejor evidencia científica disponible en este tema. Es importante mencionar que la evidencia actual en este tema es en general, de baja calidad, por lo que el nivel recomendación sigue siendo débil.

Generalmente los pacientes llegarán al comienzo del tratamiento con dolor importante, que puede estar asociado a debilidad y disminución de los rangos de movilidad. En este contexto sugiero dividir el tratamiento en 3 etapas. El avance entre las etapas debe ser progresivo, con transiciones, cuando el paciente vaya mejorando los síntomas y cumpla los objetivos en cada etapa. Es importante que el paciente note su mejoría antes de ir progresando, principalmente a través del a percepción de la disminución del dolor.

Etapa 1:

Se debe iniciar con medidas analgésicas para tratar el dolor como puede ser la utilización de corriente analgésica (TENS). A esto se debe asociar el inicio de ejercicios de elongación y terapia manual, con el objetivo de recuperar el rango de movimiento. Estos deben basarse en ejercicios movilidad pasiva del hombro para no gatillar mayor dolor. Se debe elongar el supraespinoso, subescapular, infraespinoso y no se debe olvidar el músculo pectoral menor con el objetivo de disminuir la anteversión de la escápula.

Etapa 2:

En esta etapa es importante evaluar y comenzar a tratar la diskinesia escapular (término usado para referirse a la alteración de la posición de la escápula durante el movimiento y en reposo). Para este objetivo, se pueden agregar a la rutina ejercicios concéntricos y excéntricos de los estabilizadores de escápula.

Etapa 3:

Si el paciente ha disminuido de forma considerable el dolor se debe comenzar con el fortalecimiento muscular del manguito rotador, con el objetivo de mejorar la fuerza y el correcto balance muscular. Esto se debiera realizar con especial énfasis en los ejercicios excéntricos del manguito rotador. Otro punto a discutir es definir si existen diferencias entre los resultados del tratamiento kinésico en pacientes que han realizado las pautas de ejercicios por su cuenta versus los que han recibido la asistencia de un kinesiólogo. Existen suficientes estudios que han logrado demostrar que se pueden lograr resultados similares en ambos grupos. Sin embargo, estos estudios se realizan en grupos de pacientes bajo protocolos de ejercicios estrictos y con alta adherencia a cumplir con las instrucciones de forma rutinaria, lo que no es frecuente en la población real de pacientes. En mi opinión, creo que la gran mayoría de los pacientes se beneficia de iniciar el tratamiento con la ayuda de un kinesiólogo que tenga experiencia con esta patología y que luego, con el transcurso del tiempo pueda continuar por su cuenta. Esto, una vez que haya presentado resultados favorables y haya logrado aprender una rutina de tratamiento para incorporarla en su vida diaria.

Información Bono Fonasa PAD Manguito Rotador

Fuente: Escamilla.  Optimal management of shoulder impingement syndrome. Open Acces J Sports Med, 2014

Dr. Michael Marsalli
Publicado por:
Dr. Michael Marsalli
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    • Dr. Michael Marsalli
      Dr. Michael Marsalli
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      Se hace necesario que sea evaluado por un especialista en hombros.

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    Hola dr tarde leí su pagina web me parece genial que usted se tome su tiempo en responder dudas bueno solo quiero una consulta más bien saber una segunda opinión e sido operada del manguito rotador por rotura y se me aplicó artroscopia de hombro estoy en terapia y aquí viene mi consulta es asi de dolorosa la recuperación se me esta aplicando el tratamiento de crochet pero es doloroso muy doloroso desde ya muchas gracias adiós

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    • Dr. Michael Marsalli
      Dr. Michael Marsalli
      | 06 Julio, 2015 |

      Las primeras semanas luego de la cirugía pueden ser dolorosas, pero debiera ir cediendo a medida que avanza el tiempo. Lo importante es que uno note que el dolor va bajando progresivamente.

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  • Dr. Michael Marsalli
    Dr. Michael Marsalli
    | 26 Febrero, 2015 |

    Son múltiples las causas de dolor de hombro. Para determinar que pasa en tu caso específico es indispensable que seas evaluado de forma personal por un especialista de hombro. Para más información te recomiendo que leas la siguiente nota: https://deportedoc.com/dolor-de-hombro/

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    sufri de tendinitis en el tendon supraespinoso, despues de tomar 5 sesiones de kinesiologo, el dolor persistia, el tema es que fui a hacerme una ecotomografia de partes blandas al hombro. y me salio que mi hombro estaba en perfecta condiciones, nada de inflamacion de ningun tendon, ni nada. mi dolor persiste en el hombro, ¿porque causa podria ser que persiste dolor? ¿contracturas musculares?, ¿algo asi?

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