脳卒中片麻痺患者に好発する肩関節痛はリハビリテーション阻害因子の1つである．これに対する局所注射は臨床現場で多用される手技にもかかわらず，その意義·効果に関する報告は少ない．今回我々は肩関節痛を訴える片麻痺患者34名に対し肩の超音波検査と圧痛点の調査を行った．また圧痛点に局所注射（1％リドカイン3 ml+ベタメサゾン2 mg）を行いその結果につき検討した．超音波検査では非麻痺側と比較して麻痺側に上腕二頭筋長頭腱浮腫が有意に多く認められ，同部の炎症が示唆された．棘上筋腱損傷も麻痺側に有意に多くみられた．圧痛点は上腕二頭筋長頭腱に多く認めた．また局所注射は上腕二頭筋長頭腱に行ったものが最も多く，有効例を高率に認めた．これらの結果から上腕二頭筋長頭腱の病変は片麻痺の肩関節痛に関与しており，同部への局所注射は有用であると考えられた．

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Lymphedema is defined as a swelling of the arms or legs induced by an obstruction in lymph fluid circulation or by an abnormality in lymph fluid production. In most patients, lymphedema can be diagnosed from the clinical history and physical examination. The lymphangiogram and lymphangioscintigraphy are also used as additional diagnostic tools. Lymphedema developed from an obstruction of the lymphatic system is called secondary lymphedema. Lymphedema is classified into two categories: primary and secondary, and primary lymphedema is rare and is caused by a defect at birth or a congenital lymph system abnormality. The most frequent complication with lymphedema is cellulites. The protein-rich lymph fluid can be a source of bacteria proliferation leading to cellulites, which is an infection in the subcutaneous layers. But if therapy is started from the onset, the risk of infection in edema patients can be lessened. The primary management of lymphedema consist of conservative treatment called complex decongestive physical therapy: CDP or decongestive lymphatic therapy: DLT. The treatment includes skin care, manual lymph drainage, compression therapy, and exercise with bandage or compression garment. If the conservative management does not produce a sufficient effect or the edema worsens, surgical interventions such as microsurgical lymphaticovenular anastomosis and other techniques may be indicated. In Japan, the health insurance system does not offer enough support for patients with lymphedema. The treatment of lymphedema from the early stage is usually effective, and it is therefore necessary for clinicians to have a working knowledge of lymphedema management.

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脳卒中患者への新しいリハビリテーション対応— overview —…長谷　公隆　13

脳卒中片麻痺上肢への対応…道免　和久　19

脳卒中患者の半側空間無視への対応…米田千賀子　26

脳卒中患者の歩行障害への対応…宮井　一郎　33

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