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<title>実学 肩関節障害の理学療法 | 株式会社文光堂</title>


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<meta name="description" content="基礎編では，「肩関節はどのように支えられているのか？」「肩関節はどのように動き，どのように負荷がかかるのか？」といった基礎的な疑問を解説．臨床編は，障害ごとの発生メカニズムや評価方法，保存療法・術後理学療法の実際について著者の豊富な経験や知見，科学的根拠に基づいた深度の高い内容に仕上がっている．また，評価のフローチャートや「Point」「注意点」も要所にちりばめられており，臨床での一助になるだろう">

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		<h1 class="catchCopy">長年にわたり，肩関節と真摯に向き合い続けてきた著者渾身の実学書！</h1>
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		<h1 class="title">実学 肩関節障害の理学療法<span class="version"></span></h1>
		<h2 class="subTitle">基礎と臨床の統合が導く思考と技術</h2>

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					著：村木孝行（運動器ケア しまだ病院リハビリテーション部）
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				<ul class="property"><li class="disc">B5判・380頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4729-1</li><li class="disc">2026年9月25日発行</li></ul>

				
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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">基礎編では，「肩関節はどのように支えられているのか？」「肩関節はどのように動き，どのように負荷がかかるのか？」といった基礎的な疑問を解説．臨床編は，障害ごとの発生メカニズムや評価方法，保存療法・術後理学療法の実際について著者の豊富な経験や知見，科学的根拠に基づいた深度の高い内容に仕上がっている．また，評価のフローチャートや「Point」「注意点」も要所にちりばめられており，臨床での一助になるだろう．</section><section class="preface">序文<br><br>　本書の企画について話が上がったのは，約13年前にさかのぼる．その頃，私の発信する情報や考え方に興味をもっていただき，様々な学会や研究会，研修会で肩関節障害の理学療法に関するお話しさせていただく機会が増えていた．現在でもそうだが，「教えてもらったとおりにやってみたが，うまくいかない」といった質問を受けることがしばしばある．極力大多数の症例に適した手技やエクササイズを伝えているつもりであるが，同じ疾患名の症例であっても，細かい点で千差万別なのは当然のことである．それゆえ，教えたことをそのままやるだけではうまくいかないことがあっても不思議はない．実際に自分が様々な症例に相対したときに，症例に合わせて微妙に手技を変更したり，まったく異なることをやっていたりすることもある．<br>　治療について言えば，何を目的・目標として，どのような優先順位で行うべきかが重要であり，それを正確かつ最大限に反映させた理学療法を行うことによって望ましい治療結果に結びつく．そして，最適な目的・目標，優先順位を決定するためには，病態の理解と，漏れがなく精度の高い評価が欠かせない．そのようなことを考えて症例に向き合っていると，やはり毎回同じ評価・治療にはならない．要はそこまでの思考プロセスが大事なのである．<br>　本書は基礎編と臨床編で構成されているが，基礎編はあくまで臨床編の支えとなる内容として作成した．思考プロセスにおいて基礎は大きな拠り所となる．一方で，基礎だけではすべてのケースに対応することはできない．そこで，私の実践を積み重ねた経験を基礎と織り交ぜて，可能な限り多くの思考プロセスを細かく言語化することとした．実践的な内容を目指した本書のタイトルには「実学」という言葉を入れた．本書の読者にはぜひ多くの思考プロセスとその根拠に触れ，臨床実践に活かしていただきたい．<br>　医療においてもトレンドはあり，10年もすれば主流ではなくなってしまう理論や技術もある．本書はなるべくトレンドに左右されない内容を心がけてきた．前述のように，本書の企画立案は13年ほど前である．そのためトレンドの変化とともに自分自身のコンセプトや思考プロセスが変わっていくこともあり，書き直したことも多々あった．この13年の積み重ねが本書である．ここまでを振り返ると目頭が熱くなるような，そんな一冊となった．<br>　企画からここまで長い年月待ち続けていただいた文光堂の中村晴彦氏，赤坂亮太氏には心より深謝したい．なかなか筆の進まない私は本当に手のかかる執筆者であったに違いない．私自身何度も心が折れそうな時期があったが，タイミングを見計らった励ましや，より良い本をつくるための妥協のない丁寧な校正など，誰よりも本書の価値を信じてともに走っていただいたご厚情と熱意に深く，そして熱く御礼を伝えたい．また，本書を作成するに当たり支えていただいたすべての方々に，心からの謝意を表したい．<br><br>　2026年9月<br>　村木孝行</section><section class="indexes">基礎編<br><br>肩関節の構造と運動の仕組みを知る<br>　1　肩関節はどのように支えられているのか？<br>　　1　肩甲上腕関節<br>　　　1▶関節窩の大きさ<br>　　　2▶関節内陰圧<br>　　　3▶靱帯・関節包による静的支持<br>　　　4▶筋による動的支持<br>　　　5▶肩甲骨位置の影響<br>　　2　肩鎖関節・胸鎖関節<br>　　　1▶肩甲骨の支持<br>　　　2▶鎖骨の支持<br>　2　肩関節はどのように動き，どのように負荷がかかるのか？<br>　　1　肩関節運動の定義<br>　　　1▶3平面上の運動とその問題点<br>　　　2▶3軸運動<br>　　2　挙上面，挙上角度，回旋角度の相互関係<br>　　　1▶挙上可動域<br>　　　2▶挙上角度と回旋可動域<br>　　　3▶水平面運動<br>　　3　肩関節運動中の上腕骨頭運動<br>　　4　各関節運動の相互関係<br>　　　1▶肩甲上腕リズム<br>　　　2▶肩甲骨運動と胸郭運動の関係<br>　　5　肩関節にかかる力学的負荷<br>　　　1▶肩峰下インピンジメント<br>　　　2▶関節内インピンジメント<br>　　　3▶伸張<br>　　6　モーメントアーム<br>　　　1▶肩甲骨面挙上<br>　　　2▶挙上0°位内・外旋<br>　　　3▶外転90°位内・外旋<br><br>臨床編<br><br>Ⅰ　腱板断裂<br>　1　腱板断裂の発生機序と予後<br>　　1　どのような種類の腱板断裂があるのか？<br>　　2　どのように腱板断裂が起きるのか？<br>　　　1▶外傷による断裂<br>　　　2▶腱板の変性とその影響<br>　　3　断裂に関与する力学的負荷<br>　　　1▶伸張負荷<br>　　　2▶どれくらいの伸張負荷で断裂するのか？<br>　　　3▶インピンジメント<br>　　4　断裂した腱板筋はどうなるのか？<br>　　　1▶筋萎縮と脂肪浸潤<br>　　　2▶筋の長さ<br>　　5　断裂の拡大と他組織への影響<br>　　　1▶断裂の拡大と関連因子<br>　　　2▶上腕二頭筋長頭腱<br>　　　3▶上腕骨頭の上方偏位<br>　　　4▶腱板断裂後関節症<br>　2　痛みはどのように評価するか？<br>　　1　どのようにして痛みが生じるのか？<br>　　　1▶安静時痛<br>　　　2▶運動時痛<br>　　　3▶夜間痛<br>　　2　物理的刺激を増強する因子<br>　　　1▶肩峰下インピンジメントの増強因子<br>　　　2▶関節内インピンジメントの増強因子<br>　　　3▶伸張刺激の増強因子<br>　　3　評価の実際<br>　　　1▶安静時痛・夜間痛の評価<br>　　　2▶圧痛の評価<br>　　　3▶運動時痛の評価<br>　3　肩甲上腕関節機能はどのように評価するか？<br>　　1　関節可動域<br>　　　1▶自動可動域<br>　　　2▶他動可動域<br>　　2　筋力<br>　　　1▶挙上筋力<br>　　　2▶外旋筋力<br>　　　3▶内旋筋力<br>　　3　求心性<br>　　　1▶内旋<br>　　　2▶外旋<br>　　　3▶屈曲<br>　　　4▶外転<br>　　　5▶水平屈曲<br>　　　6▶水平伸展<br>　4　肩甲胸郭関節機能の影響とその関連因子の評価<br>　　1　アライメント<br>　　　1▶下垂位<br>　　　2▶肩関節挙上位<br>　　　3▶外旋位<br>　　　4▶内旋位（結帯動作）<br>　　　5▶外転・外旋位<br>　　　6▶水平伸展位<br>　　　7▶水平屈曲位<br>　　2　肩甲上腕リズム<br>　　　1▶運動開始時<br>　　　2▶中間域<br>　　　3▶最終域<br>　　3　肩甲胸郭関節機能補助検査<br>　　　1▶肩甲骨固定検査<br>　　　2▶肩甲骨運動介助検査<br>　5　腱板断裂の保存療法では何に対し，何をするのか？<br>　　1　疼痛軽減<br>　　　1▶安静時痛・夜間痛<br>　　　2▶運動時痛<br>　　2　筋力改善<br>　　　1▶理論的背景<br>　　　2▶介入の根拠と実際<br>　6　腱板断裂術後の理学療法<br>　　1　腱板断裂に対する手術<br>　　　1▶腱板修復術<br>　　　2▶腱移行術<br>　　　3▶リバース型人工肩関節置換術（RTSA）・上方関節包再建術（SCR）<br>　　2　腱板断裂術後の理学療法<br>　　　1▶他動運動期（装具固定期）<br>　　　2▶自動運動期<br>　　　3▶抵抗運動期<br>　　　4▶難渋例に対して<br><br>Ⅱ　肩関節周囲炎（凍結肩）<br>　1　肩関節周囲炎（凍結肩）とはどのような病態か？<br>　　1　肩関節周囲炎と凍結肩<br>　　2　凍結肩はどのような疾患と捉えるべきか？<br>　　　1▶症状と経過<br>　　　2▶画像所見<br>　　　3▶素因とその影響<br>　　3　類似疾患との違い<br>　　　1▶肩峰下インピンジメント症候群（SIS）<br>　　　2▶腱板断裂<br>　　　3▶上腕二頭筋長頭腱炎<br>　2　肩関節周囲炎（凍結肩）はどのように評価するか？<br>　　1　問診<br>　　　1▶疼痛<br>　　　2▶既往歴<br>　　　3▶職業<br>　　2　圧痛<br>　　3　機能評価<br>　　　1▶ROMと運動時痛<br>　　　2▶上腕骨頭変位と痛みの評価<br>　　　3▶肩甲上腕リズム<br>　　　4▶筋機能<br>　　4　凍結肩と他の肩関節疾患の区別に関する暫定的判断<br>　　5　凍結肩のステージに関する暫定的判断<br>　3　肩関節周囲炎（凍結肩）はどのように治療するか？－保存療法と関節授動術後の理学療法<br>　　1　保存療法<br>　　　1▶ステージ1（凍結進行期）<br>　　　2▶ステージ2（凍結期）<br>　　　3▶ステージ3（寛解期）<br>　　2　関節授動術後の理学療法<br>　　　1▶関節授動術<br>　　　2▶術後理学療法<br><br>Ⅲ　肩関節不安定症<br>　1　どのように不安定になり，問題となるのか？<br>　　1　不安定症の種類<br>　　　1▶脱臼方向<br>　　　2▶外傷の有無<br>　　　3▶脱臼頻度<br>　　　4▶脱臼・亜脱臼（自己整復の可否）<br>　　2　脱臼のメカニズム<br>　　　1▶前方脱臼<br>　　　2▶後方脱臼<br>　　　3▶下方脱臼<br>　　3　脱臼による組織損傷<br>　　　1▶Bankart損傷<br>　　　2▶Hill-Sachs損傷<br>　　　3▶関節上腕靱帯損傷<br>　　　4▶筋・腱損傷<br>　　　5▶神経障害<br>　　　6▶大結節骨折<br>　　　7▶血管損傷<br>　　4　再脱臼のリスク<br>　　5　症状<br>　　　1▶脱臼不安感<br>　　　2▶痛み<br>　　　3▶関節可動域制限<br>　2　肩関節不安定症はどのように評価するか？<br>　　1　問診・画像検査<br>　　　1▶問診<br>　　　2▶画像検査<br>　　2　評価の流れ<br>　　3　関節可動域（ROM）の評価<br>　　4　不安定性の評価<br>　　　1▶関節運動による評価<br>　　　2▶上腕骨頭変位を用いた評価<br>　　5　肩関節機能の評価<br>　　　1▶肩甲上腕リズム<br>　　　2▶肩甲上腕関節<br>　　　3▶肩甲胸郭関節<br>　　　4▶胸郭機能<br>　3　保存療法では何をどのように改善させるか？<br>　　1　急性期（受傷後3週以内）<br>　　　1▶理論的背景<br>　　　2▶他動ROM運動<br>　　　3▶自動ROM運動<br>　　　4▶等尺性収縮運動<br>　　　5▶肩甲骨運動<br>　　　6▶胸郭アライメント・可動性改善<br>　　2　回復期（受傷後3～8週）<br>　　　1▶理論的背景<br>　　　2▶他動ROM運動<br>　　　3▶自動ROM運動<br>　　　4▶抵抗運動<br>　　　5▶回旋筋群促通下での挙上運動<br>　　　6▶肩甲骨運動<br>　　3　復帰期（受傷後6～8週以降）<br>　　　1▶理論的背景<br>　　　2▶閉鎖性運動連鎖（CKC）エクササイズ<br>　　　3▶プライオメトリックエクササイズ<br>　　　4▶転倒練習<br>　　　5▶各スポーツ競技における留意点<br>　4　術後理学療法はどのように進めていくか？<br>　　1　外傷性不安定症に対する手術<br>　　　1▶Bankart修復術<br>　　　2▶烏口突起移行術<br>　　　3▶追加手術<br>　　　4▶術後理学療法<br>　　2　非外傷性不安定症に対する手術<br>　　　1▶関節包縫縮術<br>　　　2▶大胸筋移行術<br>　　　3▶関節窩骨切り術<br><br>Ⅳ　オーバーヘッドスポーツの肩関節障害<br>　1　オーバーヘッドスポーツの肩関節障害はどのような病態か?<br>　　1　オーバーヘッドスポーツの特徴<br>　　　1▶オーバーヘッド動作の各位相<br>　　　2▶オーバーヘッド動作における肩関節運動<br>　　　3▶オーバーヘッド動作における肩への負荷<br>　　　4▶オーバーヘッド動作における肩関節周囲の筋活動<br>　　2　オーバーヘッドスポーツの肩関節障害<br>　　　1▶オーバーヘッドスポーツの肩関節障害の病態<br>　　　2▶発生メカニズム<br>　2　オーバーヘッドスポーツの肩関節障害はどのように評価するか？<br>　　1　問診<br>　　　1▶患者状況<br>　　　2▶疼痛<br>　　2　疼痛誘発検査<br>　　　1▶理論的背景<br>　　　2▶empty can test<br>　　　3▶hyper-external rotation test<br>　　　4▶Neer impingement signと変法（外旋位Neer）<br>　　　5▶release push test<br>　　　6▶Hawkins impingement sign<br>　　　7▶O’Brien test変法<br>　　3　圧痛評価<br>　　　1▶理論的背景<br>　　　2▶肩甲上腕関節<br>　　　3▶腕神経叢<br>　　　4▶四辺形間隙<br>　　4　アライメント評価<br>　　　1▶理論的背景<br>　　　2▶肩甲骨アライメント<br>　　　3▶胸郭アライメント<br>　　　4▶骨盤アライメント<br>　　5　ROM検査<br>　　　1▶理論的背景<br>　　　2▶肩関節ROM<br>　　　3▶胸郭回旋ROM<br>　　6　筋力評価<br>　　　1▶理論的背景<br>　　　2▶肩関節内旋位挙上（棘上筋・僧帽筋上部線維）<br>　　　3▶肩関節最大屈曲（僧帽筋下部線維）<br>　　　4▶肩関節外転位外旋（小円筋・棘下筋）<br>　　　5▶前鋸筋下部線維<br>　　　6▶elbow push test<br>　　　7▶肩甲下筋<br>　　　8▶棘下筋<br>　　　9▶側方リーチ位肩関節外転<br>　　7　肩甲骨運動<br>　　　1▶理論的背景<br>　　　2▶肩関節外転<br>　　　3▶水平伸展<br>　　　4▶肩関節外転位外旋<br>　　　5▶水平屈曲<br>　　8　上腕骨頭求心性評価<br>　　　1▶理論的背景<br>　　　2▶外旋<br>　　　3▶内旋<br>　　9　筋収縮<br>　　　1▶理論的背景<br>　　10　頚椎運動検査<br>　　　1▶理論的背景<br>　　11　動作評価<br>　　　1▶理論的背景<br>　　12　関節内インピンジメントとTOSの鑑別（最大外旋期）<br>　3　オーバーヘッドスポーツの肩関節障害はどのように治療するか？－保存療法と術後理学療法<br>　　1　保存療法<br>　　　1▶共通の理学療法介入：骨盤アライメント修正<br>　　　2▶コッキング・テイクバック期の痛みに対する理学療法<br>　　　3▶最大外旋期の痛みに対する理学療法<br>　　　4▶リリース・インパクト期の痛みに対する理学療法<br>　　　5▶フォロースルー期の痛みに対する理学療法<br>　　　6▶オーバーヘッド動作復帰プログラム<br>　　2　術後理学療法<br>　　　1▶手術療法<br>　　　2▶術後急性期（修復部位の保護：術後3～6週まで）<br>　　　3▶術後回復期（正常レベルまでの機能回復：術後3～6週から）<br>　　　4▶術後強化期（高負荷への適応：術後12～14週から）<br>　　　5▶復帰期（術後20週から）<br><br>索引</section></article>
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