京都下鴨病院で整形外科の理学療法士をしている小野志操のブログです。
肩関節・肘関節・手関節・股関節・膝関節・足関節・腰背部の術後療法や保存療法、スポーツ障害に対するリハビリテーションを行なっています。
すべては患者さんの笑顔のために」 All for a smile of patient... by OH!NO!DX

高齢者における肩関節前方脱臼

ANTERIOR DISLOCATION OF THE SHOULDER IN ELDERLY PATIENTS
S. GUMINA,  F. POSTACCHINI

J Bone Joint Surg [Br] 1997;79-B:540-3. 


Of 545 consecutive patients with anterior shoulder dislocations, 108 (20%) were aged 60 years or more at the time of injury. We reviewed and radiographed 95 of these elderly patients after a mean follow-up of 7.1 years. Axillary nerve injuries were seen in 9.3% of the 108 patients, but all recovered completely in 3 to 12 months. There were single or multiple recurrences of dislocation in 21 patients (22.1%), but within this group age had no influence on the tendency to redislocate.
Tears of the rotator-cuff were diagnosed by imaging studies or clinically in 58 patients (61%), including all who had redislocations. Sixteen patients required surgery. Eight with a single dislocation and a cuff tear had only repair of the torn cuff. Of the eight patients with multiple dislocations requiring operation, five also had a torn cuff and needed either a stabilising procedure and a cuff repair or repair of the cuff only. All patients who were operated on had a satisfactory result, with the exception of those with multiple redislocations and a cuff tear who had repair of the cuff only.
Anterior shoulder dislocation in elderly subjects is more common than is generally believed; 20% suffer redislocation and 60% have a cuff tear. Operation may be needed to repair a torn cuff or to stabilise the shoulder. Patients with multiple redislocations will probably require both procedures.

545人の肩関節前脱臼のうち108人(20%)が60歳以上であった。そのうち95人を平均7.1年間にわたって経過観察した。

腋窩神経障害が9.3%に見られたが3ヶ月から12ヶ月で完全に消失した。

108人のうち58人(61%)に臨床所見と画像所見から腱板断裂が認められた。

16人は再脱臼をして手術が必要。

そのうち8人は1回の脱臼で腱板修復術のみを施行。5人は腱板修復術と関節制動術が必要であった。残りの3人は腱板断裂が認められず関節制動術のみ施行。

 高齢者の脱臼は腱板断裂が高率に認められるが腱板断裂がなくても脱臼する場合がある。


理学療法を行う上で必要な事は如何に肩関節を安定化させるべきかということ。

関節構成体が安定するまでの6週間は外転や外旋可動域の拡大には注意を要する。

但し、過度な肩峰下組織の癒着は夜間痛の出現にも繋がる。必要な関節の安定化と不要な拘縮予防という観点が重要だ。