背景與目的：目前證據支持保守治療肩旋轉肌的撕裂，但對於肩旋轉肌完全斷裂證據就不多。本文的目的 是提供物理治療對於棘上肌肌腱完全斷裂及肌肉內縮的個案可以減輕疼痛、恢復功能及長期效果。案例描述： 1 名78 歲的女性抱怨嚴重的左肩疼痛1 個月但無外傷史。核磁共振造影 (magnetic resonance imaging, MRI) 顯示 左棘上肌腱完全斷裂而且肌肉內縮至少1.8 公分。患者同意嘗試物理治療，包括熱敷、肌肉電刺激、超音波、 手法治療和運動治療，1 週3 次直到最大進步的程度。在接受治療開始時，左肩主動關節活動是疼痛及有限的： 肩屈曲到50 度、肩外展到45 度、肩水平內收到30 度、肩在中位下的外旋角度為45 度，肩內旋在背後到T12 節的高度。結果：經過15 週27 次的物理治療，肩關節功能活動有完整進步。疼痛評分從7/10 減少到1/10。結 束治療10 個月後召回病人複檢。她報告偶爾抬肩過頭或舉重物時，左肩會酸痛 (1/10 左右)。肩膀骨科測試顯 示陽性的Neer 測試結果及陰性的Speed’s、Hawkins 和O’Brien 測試結果。上肢功能問卷 (disabilities of the arm, shoulder and hand questionnaire, DASH) 的得分為11 (4 個項目除外，如粗重的家務事、娛樂活動和性交)。結束治 療4 年後電話隨訪，仍顯示令人滿意的肩關節前屈活動角度和生活功能，DASH得分為17 ( 不包括性交)。結論： 這個案例研究的結果表明對於棘上肌肌腱完全斷裂及肌肉內縮的病人，物理治療能夠減輕疼痛，恢復肩關節的 活動，提高日常生活功能，甚至在治療結束4 年也有長期的維持效果。此病例使用代償的策略，包括過度肩胛 骨上移、向上旋轉及軀幹側傾，這些代償動作發生值得進一步探討。

Background and Purpose: Evidence is well supported for conservative treatment for patients with fullthickness rotator cu tears but scanty for a complete rupture of rotator cu .  e purpose is to demonstrate physical therapy can reduce pain, restore function and avoid surgery in the long-term basis for a patient who had a complete rupture of supraspinatus tendon with muscle retraction. Case Description: A 78-year-old female complained of severe left shoulder pain for one month with no history of trauma. Magnetic resonance imaging (MRI) showed a complete rupture of left supraspinatus tendon with muscle retraction, at least 1.8 cm. Patient agreed to try physical therapy, including hot pack with electrical muscle stimulation, ultrasound, manual therapy and therapeutic exercises three times a week until a maximal improvement was achieved. At baseline, the left shoulder active ranges of motions (ROMs) were painful and limited:  exion to 50 degrees, abduction to 45 degrees, horizontal adduction to 30 degrees, external rotation to 45 degrees at neutral, and internal rotation with hand behind the back to T12 level. Outcomes: After 27 visits of physical therapy for 15 weeks, she restored all shoulder functional ROMs. Pain score reduced from 7/10 to 1/10. She was recalled for a follow up re-examination at 10th months after discharge. She reported to have occasional soreness over her left shoulder when trying to reach above her head or lift heavy object. Her pain level was about 1/10. Orthopedic tests of the a ected shoulder showed positive for Neer’s test, and negative for Speed’s, Hawkins, and O’Brien tests. Flexilevel scale of shoulder function showed high shoulder function with score at 59/60.  e disabilities of the arm, shoulder and hand (DASH) score was 11 (4 items excluded such as heavy housework and recreational activities and sex). A phone follow-up about 4 years after discharge still revealed satisfactory shoulder flexion and DASH score at 17 (excluding sex). Conclusions: The result of this case study shows that physical therapy could decrease pain, restore shoulder ROMs, improve activity of daily living (ADL), and avoid surgery in a patient with complete rupture of supraspinatus tendon and muscle retraction even 4 years after discharge from the therapy. Compensatory strategies were noted in this patient such as excessive scapular elevation, upward rotation, and trunk side bending especially when lifting a 5-pound weight in the scapular plane in the  rst 30 degrees. Further investigation can be conducted on whether compensation strategy is appropriate or not.