洗濯物干し動作において右肩関節前面に疼痛を認めた右上腕骨近位部骨折後患者に対する理学療法

抄録

We provided physical therapy for a patient with inability to hang up laundry due to pain involving the anterior aspect of right shoulder after fracture of the proximal section of the right humerus. We observed the patient performing a sham laundry-hanging task and noted the flexion and elevation of the right scapular arch in the early phase of anterior elevation of both arms, and the adduction and introversion associated with flexion of the right shoulder. Flexion of the patient’s right shoulder was restricted to about 60°, and the patient reported pain around the right coracoid process. The shoulder movements suggested impingement between the coracoid process and the lesser tubercle of the humerus. Considering the problems of restricted range of motion of the right scapular arch and shoulder, and weakness of the muscles around the right shoulder, corrective therapy was performed for about one month. Improvements were observed in the impaired functions that were suggested as major problems; however, the sham laundry-hanging task in the standing position was still difficult to perform due to the pain in the anterior aspect of right shoulder. Therefore, the patient’s movements were more closely examined, especially in the standing posture, and mild extension, abduction and extroversion of the left hip and mild flexion/adduction/introversion of the right hip during anterior elevation of both the arms in the standing position, which caused characteristic left anterior rotation of the pelvis, were observed. This movement forced the patient to perform the task with the body turned to the right and horizontal adduction of the right shoulder. Moreover, flexion of the right scapular arch and adduction and introversion of the right shoulder appeared to be intensified in an effort to hold a bath towel at the height of the laundry pole due to the posteriorly displaced position of the right shoulder. Evaluation of the causes of these findings revealed weakness and reduced tone of the left gluteus maximus muscle; therefore, training with the primary aim of strengthening this muscle was performed. As a result, anterior elevation of both arms in a symmetric standing posture became possible with improvements in the strength and tone of the left gluteus maximus muscle, and the pain in the anterior aspect of the right shoulder disappeared. For restoration of the patient’s ability to hang up laundry, improvements in the strength and tone of the left gluteus maximus muscle were necessary, as indicated by the evaluation of the standing posture during the laundry-hanging task, in addition to the correction of the functional impairment of the right shoulder.