「肩が痛い」ケーススタディ②２６歳女性、コメディーライター編
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肩痛で悩む方々の実例から、どういうプロセスで治療していくのか、University of Southern California のJared Vagy先生のお話し｡
私自身も、ふと動かしたときに右肩が痛むのです。もう、10年以上痛くなったり、なくなったりの繰り返し。
これが四十肩と言うやつなのでしょうか？
老いの始まり。
とは言うものの、10年以上前からだから三十肩なんですけどね。
そこから四十肩に進化した口なんですけどね。
そして今となっては、五十肩すらも視野に捕らえております。
是非参考にしたいと思います。
ノートテキスト
ページ1:
Case 2 26ylo, Female, Comedy writer * Sup. / Lat. Shoulder pain secondary to a fall with an onset 3 wks ago. S/S1 factors reaching overhead (3/10) Immediate onset, 15 sec. to ease / factors None Medical history b • neck pain (persistent) - severity -Virritability -Diffuse pain Subacute Sup/lat. Pn. Subacromial Pn Syndrome? Humeral Superior glide syndrome? prior to the injury has gotten worse since the injury) add some pressure. no shoulder discomfort.
ページ2:
• flex. R 1750 AROM Objective Information 170° (60°~ 120° painful arc) 120° painful arc Subacromial P Jt. mobility syndrome? • inf. glide normal MMT normal (PV when performed @100°) Cupwardly rotate scapula Humeral Superior •Serratus ant. ○ 4/5 大 4+/5 glide Syndrome? • Lower Trap. • Humeral ER. 4/5 ® 4+/5 4+/5 14+/5 Special test •Neer •Empty can subacromial Pain cluster 2 + ® - 7 } Ⓡ- " 0 Hawkins- Kennedy Drop arm ER lag sign rotator cuff testing cluster Subacromial Po Syndrome?
ページ3:
Which test/measure should be done? Probably, she has subacromial pain syndrome insufficient Scap. upward rotation syndrome and/or humeral inferior glide syndrome ↓ So, Scapular upward rotation assist test •• rhomboid muscle length. rotator cuff dynamometry Stabilizes the humeral head & depresses it especially during shoulder flex. Lassess downward rotators: ·levator scapulae rhomboid. Tests the Strength of the muscle while MMT tests the weakness of the muscle. M
ページ4:
< Scopulor upward rotation assist test> see if ROM/PM) Pod <Rhomboid muscle length> tight Ograb the scapula (see how far it goes. bring it forward- and into upward rotation. <ER dynamometry> Break test! Compare bilatelally 06.7kg 4.5kg ) 32% 32% asymmetry Dynamo metry So, how let's link everything together (UT) P.③ 4
ページ5:
Subjective findings •Po with shoulder flex. 0 (painful arc) Objective findings •Vinf. glide " ° Neer · Empty can Hawkins-Kennedy Scap. up-rot. assist④ • rhomboid length. " • rotator cuff strength" Pn with inf. glide. → Hypotheses Subacromial pain Syndrome >• Scap. Up-rot. Syndrome Humeral superior glide syndrome Subacromial pain Syndrome scap. up-rot. Syndrome · Humeral sup. Glide syndrome We have to identify : -treat a mobility deficit? - treat a muscle performance? 5 -Serratus ant. ·lower trap weakness may play a role. 介 but MMT-4/5 - or both? St
ページ6:
Think about... • Humeral superior glide syndrome - humeral inferior glide (mobility) ?? Infra spinatus Teres minor Subscapularis Weakness (muscle performance) those act as a depresser of the humeral head When a force couple with the deltoid is combined. Does she have a mobility deficit in inf. glide? or Does she have a muscle performance deficit in inf. glide? She has. So, we don't have to mobilize it, We just have to strengthen it due to dynamometry Subscapularis D
ページ7:
How about • Scap: up-rot. Syndrome - Levator scapulae -Rhomboid Up trapezius mobility deficit low. tropezius & muscle performance deficit ⑦ Serratus ant up trapezius She has both low trapezius Serratus ant. So, what should we focus on? → (7) . Scap. up-rot mobility • Humeral inf. glide muscle performance P.8
ページ8:
Intervention •Soft tissue techniq iques. thomboid any type 6 of then Technique you prefer to address mobility deficits. •Stretch rhomboid. Put the hand behind the back to expose the medial border of grasp the The scopula. media! border provide an up. rot. Stretch •ER with guiding the scapula into up.rot. of Wrap the band internally (2~3x) a) (b) ER. D # guiding into overhead •ER with resistance chenge the vector. (pull downward) you can add manual Scap. up-rot.
ページ9:
Reviewing the interventions from the mentee. <Manual therapy Yes, for humeral infglide. But we don't need them ✓ because she has a muscle Yes performance deficit, bot a mobility deficit. - Shoulder flex. (PROM) - GH inf. glide Yes Therapeutic exs - Scap. punches with 8b wt. Yes Uppercuts with 5lb dumbell Yes - Modified push-up plus - - End-range prone Y Scapular retraction prone Additional interventions> - -Rhomboid mobilization. - Shoulder flex with band (sidelying) -perform after V Scop. up-rot mobility deficit Yes Pn④ No subacromial space. No didn't test scop. retractors. -rhomboid may be involved. Yes tight rhomboid ⑦ (2 abd; up-rot. ) Yes targets humeral inferior Glide syndrome (muscle performance)
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