肘関節屈曲を伴う肩関節屈曲運動が有効であった右肩腱板広範囲断裂の一症例

抄録

We report the case of a patient with a massive rotator cuff tear (all of the supraspinatus, upper subscapularis, and upper infraspinatus muscle fibers), which rendered raising the upper extremity impossible. The patient experienced pain when moving the clavicular portion of the pectoralis major and all of the deltoid muscle fibers. Therapeutic exercises resulted in inadequate effects. In order to reduce pain when moving the clavicular portion of the pectoralis major muscle and all of the deltoid muscle fibers, and to examine compensatory mechanisms for failure in rotator cuff function, we evaluated two-dimensional scapular motion using X-ray and surface EMG. During scapular motion, there was excessive outer displacement on the abnormal side compared with the normal side and the clavicular portion of the pectoralis major and all the deltoid muscle fibers exhibited excess muscle activity, while the middle trapezius muscle fibers exhibited low activity. Therefore, the therapeutic program was re-examined. Therapeutic exercises were developed to improve the excessive outer displacement of the scapula through its muscle function and those of the middle trapezius muscle fibers, and to control the clavicular portion of the pectoralis major and all of the deltoid muscle fibers. Through these exercises, the patient was able to raise the upper extremity. Therefore, in cases of massive rotator cuff tear, it is necessary to consider dynamic scapular motion and control muscle pain during movement due to excessive muscle activity through therapeutic exercises.