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yankeept -> Re: shoulder dislocation due to stroke?? (January 20, 2001 6:53:00 PM)
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Harleymemaw,
First off, I want to commend you for your dedication & desire to learn as much as possible. I'm a physical therapist specializing in treating stroke patients.
Pain in the hemiplegic shoulder can be a very difficult & trying experience. There is much debate in the P.T. world regarding this topic. What follows will be my side of the story, but do understand that there will be others that may disagree.
First off, surgery should not deserve a second thought. The fact that this even came up in the first place scares me.
It is my belief(and about 70% of the research will back me up), that subluxation of the shoulder does not cause shoulder pain. It is what you do to the shoulder that causes pain. And when I say "you", I mean doctors, therapists, nurses, aides, family & anyone that may have contact with the patient. Quite often a patient will be transferred from the bed with the person "helping" by pulling on the arm. This should be avoided at all costs. I have worked with many patients that have had significant shoulder subluxations, but without any pain.
The other thing that happens quite often is that someone "helps" the patient to perform passive range of motion with that arm and raises the affected arm above the head with the shoulder internaly rotated(the thumb facing towards the floor as the arm is raised). This serves to cause an impingement in the sub-acromial space (basically, the muscle tendon jams against the bone eventually causing a tear). So, whenever the arm is raised about shoulder height, the thumb should be pointing up.
The scapula(shoulder blade) and the trunk are two very important components to proper shoulder movement. A properly trained P.T. needs to assess movement at these body segments & perform proper range of movement techniques. Usually, the biggest factor involved with shooulder pain is loss of external range of motion.
As far as slings go, unfortunately most of the research shows that it really does not help to reduce subluxation. But if a sling gives your mother some relief, i would not be totally against it, as long as the sling is not on all day. Keeping the sling on for prolonged periods of time will cause more muscle shortening, resulting in more range of motion loss and then feeding into more shoulder pain eventually.
So where does that leave us? Chances are that there is an inflammation in the tendons of the shoulder. Modalities such as heat or ice coupled with an anti inflammatory cream such as hydrocortisone may help a little in treating the inflammation. But the biggest help would be to get a knowledgable P.T. in there to treat your mom & help train you to properly handle the shoulder.
I would check out the website [URL=http://www.NDTA.org]www.NDTA.org[/URL] They may be able to recommend a properly trained therapist in your area to help you out.
By the way, you haven't mentioned where you're from. I've worked with many therapists across the country, and may be able to begin to point you in the right direction. Unfortunately, a lot of times it is hard to find someone who has had a lot of experience with the hemiplegic shoulder.
When dealing with the shoulder, the adage "no pain, no gain" DEFINITELY does not apply. If there's pain as soon as you touch the arm, the shoulder blade & trunk needs to be addressed. If certain movements cause a significant increase in pain, please do NOT push through that pain.
Please let me know how things are going. Feel free to email me directly at
yankeept@mailexcite.com
Good Luck,
Brian Rosenberg, P.T.
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