2017 Volume 17 Pages 147-153
A patient with cervical spinal canal stenosis who had right shoulder pain when removing a front-opening shirt was prescribed physical therapy. We showed the patient how to undress by grasping the right hem of the front-opening shirt. When undressing, the patient exhibited poor right shoulder external rotation when pulling on the right upper garment, and rightward rotation of the thoracolumbar spine caused the right hand to move back and to the outside. Thus, the right shoulder was displaced backward, and the right scapular arch was elevated with shoulder flexion. When removing the right collar, the right scapular arch was raised further with flexion to lower the right shoulder. With right shoulder extension and external rotation and right elbow extension while maintaining the right scapular arch in the flexion position, pain was induced in the biceps long head tendon in the intertubercular sulcus by a tension load; and this pain interfered with undressing. Based on these observations, we prescribed physical therapy for right shoulder and scapular arch impairment. Right shoulder external rotation induced right hand movement toward the back and outside, and the right upper garment was placed under tension. Thus, the patient was able to remove the right collar and lower the scapular arch without pain when undressing.
