Abstract
A patient presented with difficulty with turning the steering wheel to the left when driving an automobile due to a right distal clavicle fracture. Minimally invasive osteosynthesis was performed 9 days after the injury. Physiotherapy was indicated fROM the 23rd postoperative day. At this time, the initial evaluation was performed, and the patient was prohibited fROM performing motions that involved the movement of the clavicle. This movement prohibition was lifted 40 days after the injury. In the initial evaluation, inward rotation of the right shoulder joint was observed during the operation of a steering wheel; however, flexion was poor and the patient was unable to turn the wheel to the left. Therefore, the limited range of flexion of the right shoulder joint was considered to be the cause of the impairment. A test determined that the following factors contributed to the impairment: the range of flexion of the right shoulder joint was limited to 40°, forward and downward inclination of the glenoid during abduction, forward inclination and downward rotation of the right scapula, and restricted intra-articular movement due to anterior displacement of the right humeral head. The right glenohumeral joint was treated (physiotherapy A), following which the range of flexion of the right shoulder joint increased to 65°. However, the patient was still unable to turn the wheel to the left. On the 40th postoperative day, treatment of the clavicle was permitted and a re-evaluation was performed. During right shoulder joint flexion, backward rotation of the clavicle in the sternoclavicular joint was not observed, and backward inclination and upward rotation of the scapula was insufficient. The sternoclavicular joint was treated (physiotherapy B) to improve the backward rotation of the clavicle. After the treatment, improvement was observed in upward rotation and backward inclination of the scapula. As a result, the range of the flexion of the right shoulder joint increased to 110°, and the patient was eventually able to turn the steering wheel to the left. In this case, the achievement of backward rotation of the clavicle in shoulder joint flexion was considered to be useful.
