肩旋轉肌縫合手術急性期運動介入之成效：個案報告

Exercise Training After Arthroscopic Rotator Cuff Repair: A Case Report

林詠薇(Yong-Wei Lim) ； 賴芝錦(Chih-Chin Lai)

《物理治療》 47卷4期 (2022/12) Pp. 260-270

https://doi.org/10.6215/FJPT.202212_47(4).0004

摘要

旋轉肌肌腱破裂好發於長期須有重複或持續手臂上抬動作的勞工或運動員，肩旋轉肌縫合手術的病人，術後必須背負防止外展之肩部吊帶6週減少肌腱與其接到骨頭上的距離，導致此時期肩部疼痛、關節僵硬與姿勢異常，進而影響日常生活功能及休閒活動。術後及早被動關節運動能減少術後疼痛與僵硬。因此本篇個案報告目的為利用「個案處理模式」分析呈現此個案以及使用「國際功能、失能和健康分類」分析個案目前最困擾的活動參與，根據符合個案狀況與臨床問題之文獻設定目標與介入計畫，呈現急性期運動介入之成效。個案是一名肩膀無力與疼痛的61歲男性，因棘上肌全撕裂、棘下肌與肩胛下肌半撕裂而接受關節鏡旋轉肌縫合手術，並於術後第二週開始進行物理治療。物理治療在急性期（術後0～6週）能有效地減少疼痛和發炎。個案在4週的介入後，個案休息的疼痛及日常活動的疼痛從數字評定量表（Numerical Rating Scale, NRS）2～3分進步到NRS 1～2分。在主動關節角度與被動關節活動度，彎曲分別進步20° 及32°，外展分別進步30°及40°，內轉分別進步36°及40°，外轉分別進步12°及22°，肩胛面外展分別進步了80°及72°。右側握力從16 kg進步到24 kg。功能性活動在上肢功能受損程度問卷（Disabilities of Arm, Shoulder and Hand, DASH）從44.2%進步到34.2%。個案在疼痛、被動與主動關節角度以及功能性表現在介入後皆有明顯的進步，達到目標設定，而與文獻的結論相符合，及早開始被動關節運動對於旋轉肌縫合手術患者改善疼痛及日常生活上皆有顯著幫助。本個案報告主要提供術後急性（0～6週）介入方式、介紹旋轉肌再斷的危險因子、工作強度分級與術後回到職場之機率。

關鍵字

肩旋轉肌縫合手術 ； 被動關節角度運動 ； 回到職場 ； 個案處理模式 ； 「國際功能、失能和健康分類」

並列摘要

Rotator cuff injuries are a common cause of pain and dysfunction in individuals who often perform overhead work. Patients are instructed to immobilize the affected shoulder for 6 weeks after surgery to ensure proper tendon healing. However, the consistent use of a sling can affect posture in the upper quarter body region and cause musculoskeletal pain in the shoulders. Early passive motion after surgery can help reduce postoperative stiffness and pain. This case report provides information on the elements of the client management model and describes the effectiveness of the phase I intervention protocol following rotator cuff tear repair. A 61-year-old man with right shoulder pain had a full-thickness tear of the supraspinatus and a partial-thickness tear of the infraspinatus and subscapularis. Physical therapy was initiated in the second week after arthroscopic repair. During the early stages (0-6 weeks), physical therapy plays an integral role in reducing pain and inflammation. After 1-month physical therapy, the patient experienced considerable improvements in pain, range of motion (ROM), and functional abilities. The Numerical Rating Scale (NRS) score for resting pain and pain in activities of daily living decreased from 2-3 to 1-2. The active and passive ROM, respectively, improved by 20° and 32° during flexion, by 30° and 40° during abduction, by 36° and 40° during internal rotation, by 12° and 22° during external rotation, and by 80° and 72° during scaption. The patient's right grip strength improved from 16 to 24 kg. Values on the functional abilities dimension of the arm, shoulder, and hand questionnaire (Disabilities of Arm, Shoulder and Hand, DASH) improved from 44.2% to 34.2%. This article provides evidence regarding potential complications, early exercise programs, risk factors, and measurements for return to work for patients undergoing arthroscopic rotator cuff repair.

並列關鍵字

Rotator cuff repair ； Passive range of motion exercise ； Return to work ； Client management model ； ＂International Classification of Functioning, Disability and Health＂