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shoulder dislocation due to stroke??

 
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shoulder dislocation due to stroke?? - January 18, 2001 11:36:00 AM   
harleymemaw

 

Posts: 5
Joined: January 17, 2001
From: Houston, Texas USA
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Any suggustions?.. My mom had a severe stroke on Feb. 26, 2000. Leaving her right side completely paralysed. She also has expressive aphasia, and is unable to speak.
Over the last 11 months it seems her right shoulder has disclocated. I took her to an orthopedic doctor yesterday and he said this is common?. The only way to repair it is to operate and fuse the shoulder socket and bone together. He said if he was to just put the shoulder back into position, it would just slip right back out again because of the muscles being all stretched.
I don't want to op for surgery because the risk factor for my mom is greater than just having her shoulder stay disclocated. However, I don't want my mom to be in pain either. Is there anything I can do to help repair my moms shoulder on my own???? I'm desperate for info.. Please ???
Post #: 1
Re: shoulder dislocation due to stroke?? - January 18, 2001 7:59:00 PM   
harleymemaw

 

Posts: 5
Joined: January 17, 2001
From: Houston, Texas USA
Status: offline
thank you very much for your reply. I have an appointment with a speech therapist and physical therapist consultation this coming Monday. I have printed out your reply and I am going to take it with me. Alot of this past year for me has been learn as I go. My mom's insurance limited how much therapy she was allowed. So to be honest I don't feel she was helped much at all. I took over full caregiver control within two months after her stroke. this included all physical, occupational and speech therapy. But now that she is back on Medicare with a supplement insurance as of this year, I plan on getting her all the help I can. In your opinion... Is there anyway I myself can gradually get her shoulder back into it socket.. Keep in mind, surgery is out.. because its too risky..
I currently keep her arm propt up some on a pillow from her elbow to finger tips. I have been doing this since day one. however, it probably isn't helping because i guess her shoulder wouldn't have dislocated!!!. I massage the area 30-45 minutes a day hoping this will help contract the muscles...
when you say "support the shoulder when sleeping" do you mean keep the arm extended away from her side? or just have her elbow resting on the wedge? again thanks for your comments.

(in reply to harleymemaw)
Post #: 2
Re: shoulder dislocation due to stroke?? - January 19, 2001 11:23:00 AM   
harleymemaw

 

Posts: 5
Joined: January 17, 2001
From: Houston, Texas USA
Status: offline
Hi Bobcat, once again thanks for your reply..However, I'm a little confused on your comment about subluxation vs disclocation. I can tell you that she has never fallen or had any major jolt that I feel would have knocked it out of place. However the x-rays they took this past Wednesday definetly shows the upper arm ball in front of the shoulder socket by a distinctive distance...

quote:Please note that there is a qualitative distinction between dislocation and subluxation. Some people use the terms interchangeably, but my experience is subluxation usually refers to the joint components slipping out of full congruency as the result of prolonged traction resulting from the effect of gravity on the upper arm, in combination with some abnormal configuration of the shoulder blade due to some loss of control of that latter component. unquote..

you speak very professionally and I appreciate it. However, some of it goes over my head... I can give you a little more background... My mom would be completely bed ridden if it weren't for me.. She has "NO" use of her right side whatsoever. half the time she doesn't even act like its there!!. I get her up out of bed with a hoyer lift. From there into her wheel chair. from there into her recliner from there back to bed. I sit her up on the side of the bed to help keep her stomach muscles strong. But as for movement of her right shoulder she does not do any of it by her self. the only activity the shoulder receives is by me. she doesn't roll in bed either. She sleeps on her back at all times.

However, once again, I've printed all your comments out and I will take this page with me also monday and show the physical therapist. I think the taping will be out because, my moms skin is VERY sensitive and I feel it would cause her skin to rip.
Again thanks for everything.. to be honest you've been more helpful with knowledge over these last couple of days than anyone I've dealt with the last 10 months!!!

(in reply to harleymemaw)
Post #: 3
Re: shoulder dislocation due to stroke?? - January 21, 2001 12:53:00 AM   
yankeept

 

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Joined: October 30, 1999
From: Ft Lauderdale, FL
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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.

(in reply to harleymemaw)
Post #: 4
Re: shoulder dislocation due to stroke?? - February 1, 2001 1:33:00 PM   
chrishkpt

 

Posts: 23
Joined: January 30, 2001
From: hong kong SAR
Status: offline
harleymemaw:
your love and concern to your mother is really touching and appreciated. Keep it on .
Concerning the hemiplegic shoulder pain, i agree with yankeept that most likely the shoulder subluxation or dislocation itself is not the cause of the shoulder pain, which is demonstrated by many researh in the past. They find that the most likely causative factor would be 'Adhesive Capsulitis' i.e. frozen shoulder.
So, i will suggest while continuing your movement therapy to your mother like those of Bobath , Brunnstrom , PNF...... also consider orthopedic choices like doing a 'CORRECT' manner of passive mobilisation to the GH and scapulothoracic jts, make use of electrical stimulation for the rotator cuff muscles, use of thermal modalities like Ultrasound or SWD to kill pain and try to maintain the resilience and flexibility of the soft tissues, which then canbe accompanied by other mobilisation ex. Besides, avoidence of movements which can easily sublux her shoulder jt is important. hope these help =)

by the way, as far as i know, eleectrical stimulation is the only evidence-based treatment to shoulder subluxation. Pls try to correct me if this is wrong. thx.

(in reply to harleymemaw)
Post #: 5
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