肩関節モビライザーと挙上位自動運動を用いた腱板断裂術後早期後療法の有用性

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Early passive exercises after an operation for a rotator cuff tear often creates difficulty due to pain and increased muscle tonus. We developed a new rehabilitation protocol using an original shoulder mobilizer and an active exercise in the supine flexed position. The objective of this study was to compare the ROM and pain of the shoulder between the former and new protocol. Fifty-two shoulders were classified as group I (GI); no tendon-to-bone repair, or group II (GII); with a tendon-to-bone repair. In the former protocol, passive exercises started the next day after the surgery (GI) or in 1 week (GII). In our new protocol, the active exercises and the mobilizer started the next day; no passive exercises were applied. There were 10 former-GI, 9 new-GI, former-GII, and 14 new-GII. The postoperative passive flexion (Flex), the external-rotation (ER), and the internal-rotation (IR), and the amount of pain relief suppository used postoperatively were evaluated. The ROM (deg.) was Flex (1w/2w/4w); 109/139/133, ER; 34/53/44, IR 44/53/54 in the former-GI, Flex; 130/144/154, ER 51/71/70, IR; 49/59/54 in the new-GI, Flex; 117/134/145, ER 43/60/65, IR; 36/35/46 in the former-GII, Flex; 117/139/153, ER 37/53/63, IR; 44/52/53 in the new-GII. All motions but the ER in GII improved in the new protocol. The amount of suppositories used in day 1 and 2 significantly increased in the new-GII than the former-GII; it is probably because the exercises started earlier in the new protocol than the former protocol. Favorable ROM was obtained in most motions without any passive exercises by using the mobilizer and the active exercise. It is considered that the active exercises assisted in getting better concentric motion of the humeral head and the mobilizer provided muscle relaxation. To improve ER in GII, additional exercises should be considered.

肩関節モビライザーと挙上位自動運動を用いた腱板断裂術後早期後療法の有用性

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