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		<h1 class="catchCopy">ベテラン理学療法士による，臨床での創意工夫！その技術の集大成!!</h1>
		

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					編集：橋本雅至（大阪河﨑リハビリテーション大学教授）
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					<span class="transparent">編集</span>　村西壽祥（大阪河﨑リハビリテーション大学准教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">好評シリーズの第3弾．既刊テーマと同様，肩関節機能障害に対する敏腕理学療法士の技術とコツを12テーマに分けて解説．前半では，病態を理解するための機能解剖と運動学，理学療法士が押さえておくべき手術のポイント，運動療法につなげるための機能評価を紹介．後半では，日常臨床でよく診る，あるいは問題になりやすい機能障害として，軟部組織の痛み，関節可動域制限，筋機能低下，関節不安定症を取り上げ，臨床で実際に行われている機能的特徴を踏まえた理学療法手技をレクチャー．また人工関節置換術後理学療法や投球動作への介入，さらには乳がん術後の上肢機能再建のためのアプローチも掲載．本書にはこれまで紹介されていない敏腕PTならではの技術のコツも要所に紹介されており，長年の創意工夫により臨床現場で行われ結果を出している技術の集大成となる一冊．</section><section class="preface">［臨床実践　肩関節の理学療法］　序文<br><br>　本書は「教科書にはない敏腕PTのテクニック」シリーズの第3弾として，実際に臨床現場で行われ，結果を出している肩関節障害に対する理学療法テクニックを解説するという編集方針にて企画いたしました．肩関節という複雑な構造と機能を有する部位に着目し，臨床上工夫された評価方法や運動療法を多く掲載しました．<br>　本書の前半は，理学療法士が知っておくべき肩甲上腕関節や肩甲胸郭機能を含めた肩複合体の機能解剖や運動学，肩関節疾患の病態と手術，機能評価について解説しています．大きな可動性と安定性の両面を特徴とする肩複合体の機能評価ではさまざまな工夫が必要であり，そこから導き出される結果は有益な運動療法へとつながっていくでしょう．<br>　後半の各論では多様な肩関節障害に対する評価のポイントや工夫，臨床で実際に行っているアプローチについて紹介しています．腱板断裂や肩関節脱臼は肩甲上腕関節の病変ではありますが，痛みや機能低下はその病変だけの問題にとどまらず，さまざまな身体機能に影響を及ぼします．どの各論においても肩甲上腕関節だけでなく，肩甲胸郭・脊柱を含めた体幹や下肢機能の重要性が解説されており，局所だけを診ていては痛みや機能の改善につながらないことは共通していると思います．その共通認識に加え，著者の臨床での工夫を是非とも参考にしていただきたいと思います．近年，治癒や手術が困難であった上腕骨近位端骨折や広範囲腱板断裂に対してリバース型人工肩関節が導入されるようになりました．新しい人工関節のコンセプトやバイオメカニクスをわかりやすく解説しています．また，がんのリハビリテーションに対する診療報酬が算定されるようになりました．がん治療による特有の肩関節障害に対する理学療法士のアプローチについて，知っておくべき事項も多く含んでいます．<br>　理論的背景を優先した理学療法実践に加えて，本書で執筆いただいた先生方は臨床で患者に向き合い，日頃の発想や感性を大事にされつつ現場で創意工夫し，成果を上げている理学療法評価や治療のテクニックが大変重要であるという考えを読者と共有したいと考えられています．これまで紹介されていない敏腕PTならではの技術のコツも要所に盛り込まれています．本書が肩関節に対する理学療法へ積極的に挑戦し，対象者の満足を得るための結果にこだわった理学療法の臨床実践に貢献し得ることを心より願っています．<br><br>2018年5月<br>大阪河﨑リハビリテーション大学　橋本雅至<br>大阪河﨑リハビリテーション大学　村西壽祥</section><section class="indexes">病態・評価・治療方針の理解<br>　肩の機能解剖を理解する<br>　　Ⅰ　肩関節を構成する骨格，関節・靱帯の構造<br>　　　1　肩関節の基本骨格<br>　　　2　肩関節複合体の関節・靱帯<br>　　Ⅱ　肩の圧痛点<br>　　Ⅲ　肩関節を構成する骨と筋の触察 <br>　　　1　骨の触察<br>　　　2　肩甲上腕関節に作用する主要な筋<br>　　　3　肩甲胸郭関節に作用する筋<br>　　　4　頸部・胸郭に作用する筋<br>　肩の運動を理解する<br>　　Ⅰ　肩複合体の構造と組織<br>　　　1　肩甲上腕関節<br>　　　2　第2肩関節（肩峰下関節）<br>　　　3　肩甲胸郭関節<br>　　Ⅱ　肩複合体の運動学と病態運動学<br>　　　1　肩複合体の運動学<br>　　　2　肩複合体の病態運動学<br>　肩の病態および外科的治療を理解する<br>　　Ⅰ　腱板断裂<br>　　　1　後上方断裂に対するARCR<br>　　　2　前上方断裂に対するARCR<br>　　Ⅱ　反復性肩関節脱臼<br>　　　1　鏡視下Bankart修復術<br>　　Ⅲ　変形性肩関節症<br>　肩の機能評価に基づいた運動療法を理解する<br>　　Ⅰ　病態判別の重要性<br>　　　1　把握すべき疼痛の種類と発生機序<br>　　　2　拘縮の判別<br>　　　3　筋機能異常の判別<br>　　Ⅱ　筋機能異常の評価<br>　　　1　肩甲骨の動きの評価<br>　　　2　肩甲骨の誘導・固定による判別<br>　　Ⅲ　拘縮の主要因と判別方法<br>　　　1　GH関節の拘縮が主要因と考えられる現象<br>　　　2　GH関節性拘縮の部位判別<br>　　　3　関節包内の“あそび”の維持・改善<br>　　　4　ST関節の拘縮が主要因と考えられる現象<br><br>実践と結果に基づく理学療法手技<br>　軟部組織由来の痛みの原因を理解し介入する<br>　　Ⅰ　肩関節周囲軟部組織の機能<br>　　　1　静的安定化機構<br>　　　2　動的安定化機構<br>　　Ⅱ　軟部組織由来の疼痛の病態・評価<br>　　　1　疼痛の原因となる物理的刺激<br>　　　2　肩関節の疼痛の解釈<br>　　Ⅲ　理学療法プログラムの実際<br>　　　1　評価の実際<br>　　　［CT］拘縮と物理的刺激との関連性<br>　　　2　理学療法の実際<br>　　　［CT］外旋の可動域訓練<br>　肩の機能障害の特徴をふまえて介入する─関節可動域制限<br>　　Ⅰ　肩関節可動域制限とは<br>　　　1　肩関節疾患の概要<br>　　　2　肩関節可動域制限に対する理学療法<br>　　　［CT］肩部の関節可動域制限に対するアプローチのポイント<br>　　　3　肩関節可動域制限に対する運動療法のプログラム<br>　　Ⅱ　理学療法プログラムの実際 <br>　　　1　第I段階：疼痛と筋痙縮期<br>　　　2　第II段階：拘縮期<br>　　　3　第III段階：機能回復期<br>　肩の機能障害の特徴をふまえて介入する─肩甲胸郭関節機能低下<br>　　Ⅰ　正常な肩関節運動における筋機能 <br>　　　1　関節運動に必要な筋機能<br>　　　2　肩甲胸郭関節の筋機能<br>　　Ⅱ　肩関節疾患患者の筋機能 <br>　　　1　病態に起因する筋機能異常<br>　　　2　肩甲胸郭関節の筋機能異常が引き起こす問題<br>　　Ⅲ　肩甲胸郭関節の機能向上に必要な要素 <br>　　　1　肩甲骨周囲筋の活動<br>　　　2　肩甲骨の安定性<br>　　　［CT］肩甲骨の動きをアシストする<br>　　Ⅳ　理学療法プログラムの実際 <br>　　　1　肩甲骨アライメントの評価<br>　　　2　肩甲胸郭関節の可動性を獲得する<br>　　　3　体幹へのアプローチ<br>　　　4　肩甲骨周囲筋へのアプローチ<br>　肩の機能障害の特徴をふまえて介入する─腱板の筋機能低下<br>　　Ⅰ　肩関節安定化機構 <br>　　　1　静的安定化因子<br>　　　2　動的安定化因子<br>　　Ⅱ　筋機能低下と肩峰下インピンジメント症状<br>　　　1　第2肩関節機能<br>　　　2　肩峰下インピンジメント症状<br>　　Ⅲ　理学療法プログラムの実際 <br>　　　1　腱板機能不全の評価<br>　　　2　腱板機能の改善<br>　　　［CT］腱板修復術術後の注意点<br>　肩の機能障害の特徴をふまえて介入する─肩関節不安定症<br>　　Ⅰ　関節不安定症とは <br>　　　1　反復性肩関節脱臼の分類<br>　　　2　関節唇について<br>　　　3　手術適応<br>　　　4　疫学<br>　　　5　初期固定について<br>　　　6　Bankart修復術<br>　　Ⅱ　理学療法プログラムの実際 <br>　　　1　肩関節不安定症のリハビリテーション<br>　　　2　理学療法評価<br>　　　［CT］肩関節不安定症の筋力評価<br>　　　3　運動療法<br>　人工関節の特徴をふまえて介入する─術後肩関節機能の獲得<br>　　Ⅰ　人工関節の特性を知る <br>　　　1　人工肩関節の変遷<br>　　　2　人工関節の種類とその適応および特性<br>　　Ⅱ　人工関節のバイオメカニクスを理解する <br> 　　1　medialized type（In-lay タイプ）<br> 　　2　lateralized type（On-lay タイプ）<br>　　Ⅲ　理学療法プログラムの実際 <br>　　　1　HA，TSAに対する理学療法<br>　　　2　RSAに対する理学療法<br>　　　［CT］RSAの構造に配慮した可動域運動<br>　　　3　RSAの術後に考慮すべきこと<br>　　　4　表面筋電図を用いたRSA 症例と健常者（若年者）の肩関節周囲筋の筋活動の違い<br>　運動連鎖を理解し投球障害肩の改善・予防に向き合う<br>　　Ⅰ　障害部位の推察─病態評価としてのストレステストとスクリーニング方法─ <br>　　　1　問診と障害の推測<br>　　　2　障害別の病態評価と運動療法の方向性を導くためのスクリーニング方法<br>　　Ⅱ　運動機能評価 <br>　　　1　肩関節運動機能評価<br>　　　2　体幹・下肢運動機能評価<br>　　　3　投球動作の評価─スローイングアーム（投球腕）の動きに着目して─<br>　　　［CT］テーピングを用いた評価および予防的アプローチ<br>　　Ⅲ　理学療法プログラムの実際 <br>　　　1　肩関節運動機能の改善エクササイズ<br>　　　2　体幹・下肢運動機能の改善エクササイズ<br>　　　3　スローイングドリル<br>　　　4　投球プログラム<br>　乳がん術後の上肢機能の再建をねらう<br>　　Ⅰ　乳がんと上肢機能障害<br>　　Ⅱ　乳がん術後の肩の機能障害 <br>　　　1　手術による影響<br>　　　2　制限される運動方向と日常生活への影響<br>　　Ⅲ　リンパ浮腫 <br>　　　1　リンパ浮腫（予防期）<br>　　　2　リンパ浮腫発症後<br>　　Ⅳ　進行がん・終末期にみられる肩の機能障害 <br>　　Ⅴ　肩の機能障害に対するアプローチ <br>　　　1　術前評価と指導<br>　　　2　術後評価とアプローチ<br>　　Ⅵ　リンパ浮腫の評価とアプローチ <br>　　　1　リンパ浮腫の評価<br>　　　2　リンパ浮腫のアプローチ<br>　　　［CT］上肢浮腫に対する圧迫方法の選択<br><br>索　引 <br><br>［CT］＝クリニカル・テクニック</section></article>
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