SSTattler: The motion of the shoulder is very complex; we will give you some examples for your shoulder motion & therapy but you have to ask your doctor or physiotherapy for your specific injury and specific type of therapy. A sling may be necessary for some therapy activities but as the patient begins to recover slings are of no value at this point.
Shoulder Subluxation From Wikipedia, the free encyclopedia.
Glenohumeral (or shoulder) subluxation is defined as a partial or incomplete dislocation of the shoulder joint that typically results from changes in the mechanical integrity of the joint. Subluxation is a common problem with hemiplegia, or weakness of the musculature of the upper limb. Traditionally this has been thought to be a significant cause of post-stroke shoulder pain, although a few recent studies have failed to show a direct correlation between shoulder subluxation and pain.
The exact etiology of subluxation in post-stroke patients is unclear, but appears to be caused by weakness of the musculature supporting the shoulder joint. The shoulder is one of the most mobile joints in the body. To provide a high level of mobility the shoulder sacrifices ligamentous stability and as a result relies on the surrounding musculature (i.e., rotator cuff muscles, latissimus dorsi, and deltoid) for much of its support. This is in contrast to other less mobile joints such as the knee and hip, which have a significant amount of support from the joint capsule and surrounding ligaments. If a stroke damages the upper motor neurons controlling muscles of the upper limb, weakness and paralysis, followed by spasticity occurs in a somewhat predictable pattern. The muscles supporting the shoulder joint, particularly the supraspinatus and posterior deltoid become flaccid and can no longer offer adequate support leading to a downward and outward movement of arm at the shoulder joint causing tension on the relatively weak joint capsule. Other factors have also been cited as contributing to subluxation such as pulling on the hemiplegic arm and improper positioning.
Diagnosis can usually be made by palpation or feeling the joint and surrounding tissues, although there is controversy as to whether or not the degree of subluxation can be measured clinically. If shoulder subluxation occurs it can become a barrier to the rehabilitation process. Treatment involves measures to support the subluxed joint such as taping the joint, using a lapboard or armboard. A shoulder sling may be used, but is controversial and a few studies have shown no appreciable difference in range-of-motion, degree of subluxation, or pain when using a sling. A sling may also contribute to contractures and increased flexor tone if used for extended periods of time as it places the arm close to the body in adduction, internal rotation and elbow flexion. Use of a sling can also contribute to learned nonuse by preventing the functional and spontaneous use of the affected upper extremity. That said, a sling may be necessary for some therapy activities. Slings may be considered appropriate during therapy for initial transfer and gait training, but overall use should be limited. As the patient begins to recover, spasticity and voluntary movement of the shoulder will occur as well as reduction in the shoulder subluxation. Slings are of no value at this point.
Functional electrical stimulation (FES) has also shown promising results in treatment of subluxation, and reduction of pain, although some studies have shown a return of pain after discontinuation of FES. More recent research has failed to show any reduction of pain with the use of FES.
Logical treatment consists of preventive measures such as early range of motion, proper positioning, passive support of soft tissue structures and possibly early re-activation of shoulder musculature using functional electrical stimulation. Aggressive exercises such as overhead pulleys should be avoided with this population.
References
- Teasell RW: "The Painful Hemiplegic Shoulder". Physical Medicine and Rehabilitation: State of the Art Reviews 1998; 12 (3): 489-500.
- Boyd EA, Goudreau L, O'Riain MD, et al.: A radiological measure of shoulder subluxation in hemiplegia: its reliability and validity. Arch Phys Med Rehabil 1993 Feb; 74(2): 188-93
- Brandstater ME: Stroke rehabilitation. In: DeLisa JA, et al., eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia: Lippincott-Raven; 1998:1165-1189.
- Chae J, Yu DT, Walker ME, et al.: Intramuscular electrical stimulation for hemiplegic shoulder pain: a 12-month follow-up of a multiple-center, randomized clinical trial. Am J Phys Med Rehabil. 2005 Nov; 84(11): 832-42
- Chantraine A, Baribeault A, Uebelhart D, Gremion G: Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil 1999 Mar; 80(3): 328-31
Shoulder Subluxation From Wikipedia, the free encyclopedia.
CVA Stroke Series Preventing Shoulder Pain
Published on Jan 25, 2013Standard YouTube License @ Odessa College
CVA Stroke Series Improving Function and Awareness
Published on Jan 25, 2013Standard YouTube License @ Odessa College
DeRoyal(R) Arm Slings
Uploaded on Dec 15, 2009The DeRoyal(R) Specialty Arm Sling is durable navy canvas construction with deep pocket design. To purchase your own DeRoyal(R) Specialty Arm Sling, just visit us at Rehabmart.com: http://www.rehabmart.com/category/Arm_Slings.htm
Standard YouTube License @ Hulet Smith
DeRoyal Pro Shoulder Support from Optomo
Uploaded on Jun 10, 2011The DeRoyal Pro Shoulder Support is anatomically designed shoulder support is designed to provide stability and focused compression.
This product and others like it are available at: http://www.rehabmart.com/category/Arm_Slings.htm
Video Transcription:
Hi, I'm James, and today I want to show you the DeRoyal Pro Shoulder Support. This is it, wearing it on the left shoulder. But with its unique design, it can be worn on the left or the right shoulder, and you don't need two different sorts of braces. The measurement is taken around the top of the bicep, and then you simply look on the Internet to find the right size for you on the chart. That's all available on Optomo.com.au.Now the DeRoyal Pro Shoulder Support is made of a material called neotex. It's a little bit like a wetsuit material, and it wicks away the moisture so you can wear it for a long period of time without getting overly sweaty.
Now, the DeRoyal Pro Shoulder Support should be used for warmth and stability. It provides a medium level of structure. I'd feel quite comfortable playing football in this, but I wouldn't want to get out there and have to rely on it to provide 100% stability for a sore shoulder. You might want to use it for arthritis or a little bit of subluxation.
This shoulder support here is simply Velcro, and you can adjust that as you deem necessary. And that's it. That is the DeRoyal Pro Shoulder Support. It's in stock and available now on Optomo.com.au.
Standard YouTube License @ Optomo Australia
The Comfort Sling Video
Published on May 18, 2012Welcome to the comfort sling!
The comfort sling was designed out of necessity earlier this year when my friends sister had a shoulder surgery and was forced to immobilize her arm. Well, if anyone has ever worn those flimsy, confusing emergency room issued slings, you'll know they are extremely uncomfortable! The strap digs into your neck and near impossible to put on by yourself! Besides which, they do NOT immobilize your limbs!
So Theresa set out to make her sister more comfortable and it resulted in this amazing sling!
For the first time in 8 months following surgery, after wearing the comfort sling for just a short amount of time, Theresa's sister was finally pain free. This sling comfortably and completely immobilized her affected arm and she could finally rest without pain.
This sling is made out of approximately 1.5 yards of prewashed 100% cotton and can be adjusted to fit any adult frame easily. It is snug and non-binding across the back and sides. The shoulder strap length is adjustable also. It is completely machine washable, and comes in a variety of colors and patterns. ORDERS can be requested at "thecomfortsling@aol.com". Your request will be responded to within 24 hours.
Standard YouTube License @ Theresa Harris
CarePlus® Arm Sling User Tutorial
Published on Aug 12, 2012CarePlus® Arm Sling provides support for a broken or injured arm https://www.careplusonline.com.au
Features & Benefits:
- Adjustable Shoulder Strap And Foam Pad For Comfort.
- Breathable Polyester Mesh To Allow Air Circulation.
- Allows Injured Shoulder Or Arm Muscles To Relax.
- Arm Pocket Folds Inward For Shorter arms.
Creative Commons Attribution license @ CarePlus Australia
How to Wear an Arm Sling, How to Make a Sling
Published on Mar 1, 2012http://collegeteamdoctor.com - How to put on an arm sling demonstrated by specialists in joint and bone injuries. How to wear your arm sling and maximize comfort.
Standard YouTube License @ WilliamWinternitz's channel
Fitting a Donjoy Immobiliser Sling
Uploaded on Jan 5, 2009Instructional video showing how to fit a Donjoy abduction immobiliser sling and a cloth immobiliser sling. Useful for patients following shoulder reconstruction and rotator cuff repairs when required to wear a sling. Also shown are techniques to passively move the shoulder when allowed by the surgeon, how to wash under the arm and how to position for sleeping.
Standard YouTube License @ cracker2204
Putting on the Hemiparesis Subluxation Sling (1 of 2)
Published on Oct 9, 2012Standard YouTube License @ sublux sling
How to put on the Hemiparesis Subluxation Sling
Published on Oct 9, 2012Many people have asked for a video on how to put our sling on... well here it is.
Standard YouTube License @ sublux sling
Physical Therapy Treatments : How to Treat Subluxation
Uploaded on Jul 10, 2010To treat subluxation of the shoulder, use a sling and an exercise ball to strengthen the shoulder muscles. Prevent further injury from subluxation with help from a physical therapist in this free video on physical therapy treatments.
Expert: Tricia Trinque MHE, PT Contact: www.seabreezephysicaltherapy.com Bio: Tricia Trinque MHE, PT is a physical therapist with more than 25 years of experience. Filmmaker: Leonora Fishbein
Series Description: Physical therapy treatments are beneficial for many injuries and illnesses, from gout to arthritis and fractured bones. Learn an array of stretches and exercises to relieve pain and tension from illness and injury with help from a physical therapist in this free video series on physical therapy treatments.
Standard YouTube License @ ehow Health
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