Orthopaedic Manual Physical Therapy for Shoulder Pain and Impaired Movement in a Patient With Glenohumeral Joint Osteoarthritis: A Case Report
Michael S. Crowell, PT, DSc1,2, Bradley S. Tragord, PT, DSc3
Journal of Orthopaedic & Sports Physical Therapy, 2015, Volume: 45 Issue: 6 Pages: 453-461 doi:10.2519/jospt.2015.5887
Study Design
Case report.
Background
Comprehensive treatment strategies are needed for individuals with glenohumeral joint osteoarthritis (OA), especially when they are young and active. Prior dislocation, with or without subsequent shoulder stabilization surgery, complicates the clinical presentation and increases the risk of OA progression. The purpose of this case report was to describe an orthopaedic manual physical therapy approach used in a patient with glenohumeral joint OA who presented with shoulder pain and impaired movement.
変形性肩関節症への包括的な治療戦略が必要である、特に患者が若く活動的である場合には。脱臼への肩の安定性手術の有無に関わらず、脱臼は臨床症状を複雑化し、OAの進行リスクを高めることになる。このケースレポートの目的は、肩痛と運動異常を呈す変形性肩甲上腕関節症者への整形外科的徒手理学療法アプローチを示すことであった。
Case Description
A 38-year-old male military officer presented with left-shoulder pain of 2 months in duration that was unrelieved with a subacromial injection. He reported a history of anterior-inferior dislocation with subsequent stabilization surgery 15 years prior and arthroscopic subacromial decompression 2 years prior. Physical examination demonstrated painful limitations in shoulder elevation and internal/external rotation movements, stiffness with testing using accessory glides, and rotator cuff and scapular musculature weakness associated with pain.
38歳男性、military officer,2か月持続する左肩痛（肩峰下への注射で緩和せず）を呈す。
前下方脱臼への安定化手術を15年前、鏡視下肩峰下除圧術を2年前に受けた。
理学検査の結果、肩の挙上、内旋、外旋運動に痛みによる制限があり、副運動テストによりスティフネス、そして痛みによるローテーターカフと肩甲帯の筋力低下があった。
Outcomes
Treatment consisted of 5 sessions provided over 4 weeks. The plan of care included manual physical therapy, exercises, and progressive functional activities specifically tailored to the patient's clinical presentation. Shoulder Pain and Disability Index scores decreased from 43% to 17%, and the Patient-Specific Functional Scale average score improved from 3.0 to 7.3 out of 10. After 4 additional weeks of a home exercise program, the Shoulder Pain and Disability Index score was 4% and Patient-Specific Functional Scale average score was 9.0. Improvements in self-reported function were maintained at 6 months. Four “booster” treatment sessions were administered at 9 months, contributing to sustained outcomes through 1 year.
4週間に渡って、5回の治療が行われた。治療プランは徒手的理学療法、エクササイズと患者の臨床症状に合ったprogressive functional activities（漸進的機能的活動、トレーニング？）を特異的に行った。Shoulder Pain and Disability Index scoresは43％から17％に減少し、the Patient-Specific Functional Scale average scoreは10点中3.0から7.3に改善した。ホームエクササイズプログラムを実施後のさらに4週間後には、Shoulder Pain and Disability Index scoresは4％、Patient-Specific Functional Scale average scoreは9.0＆改善した。自己報告された機能の改善は6か月後で維持されていた。
9か月後にFour “booster” treatment sessionsが施され、1年間のアウトカムの維持に貢献した。
Discussion
In a young, active patient with glenohumeral joint OA, clinically meaningful short-term improvements in self-reported function and pain, maintained at 1 year, were observed with manual physical therapy and exercise.
臨床的に意味のある短期間の改善を示した。
Level of Evidence
Therapy, level 4