Week 10 Hemiplegic Shoulder

Question 1

Postural Alignment: Pelvis and Trunk. What needs to be observed?

Answer 1

Observe the pelvis first and it’s the effect on spinal alignment.

Question 2

Postural Alignment: Pelvis and Tunk. Where would be weight placed?

Answer 2

On one side of the pelvis resulting in lateral spine flexion.

Question 3

Postural Alignment: Pelvis and Tunk. What would happen to the trunk if one side of the pelvis will result in lateral spine flexion?

Answer 3

Shortening of the trunk on the non-weigth bearing side.

Question 4

Postural Alignment: Pelvis and Tunk. Often a posterior tilt will result in?

Answer 4

Spinal flexion.

Question 5

Postural Alignment: Pelvis and Tunk. What would happen to specific muscles if a posterior pelvic tilt will be present

Answer 5

Anterior abdominal muscles are shortened and posterior are elongated.

Question 6

Postural Alignment: Pelvis and Tunk. What does OT have to do?

Answer 6

Observe and identify malalignment in order to successfully treat UE dysfunction.

Question 7

Postural Alignment: Scapula. What is a normal resting position?

Answer 7

The scapula is flush on the ribcage and upwardly rotated.

Question 8

Postural Alignment: Scapula. What should be the distance of the scapula in relation to the vertebral column?

Answer 8

The distance between the inferior angle and vertebral column should be greater than the medial border and the vertebral column.

Question 9

Postural Alignment: Scapula. In hemiplegic clients what is the position of the scapula?

Answer 9

Downward rotation

Question 10

Postural Alignment: Scapula. What are the reasons for the downward rotation in the scapula in hemiplegic clients?

Answer 10

Might be due to;
Lateral flexion to hemiplegic side
The generalized weakness of muscles that orient the scapula and unopposed muscles pulling scapula down.

Question 11

Postural Alignment: Glenohumeral Joint. What structures impact the alignment and stability of the glenohumeral joint?

Answer 11

Pelvic/trunk, ribcage, and scapula alignment.

Question 12

Postural Alignment: Glenohumeral Joint. What is needed for the stability of the joint?

Answer 12

The angle of the glenoid fossa when facing forward, upward, and outward.
Supports of the scapula on the ribcage
Humeral head in the fossa by the supraspinatus
Support from superior capsule and contraction of deltoid and cuff muscles.

Question 13

Postural Alignment: Glenohumeral Joint. Any ligament, muscle, or tendon can impact and result in the shoulder?

Answer 13

subluxation

Question 14

What is the typical alignment of the humerus after a stroke?

Answer 14

IR which blocks a forearm rotation

Question 15

The control of the forearm is also blocked when the wrist is in what position?

Answer 15

flexion and ulnar deviation (typical stroke)

Question 16

Intrinsic Atrophy results in?

Answer 16

Claw hand.

Question 17

When is subluxation more common?

Answer 17

Flaccid tone. Often caused by mechanical fail and the weight of the arm.

Question 18

Inferior Subluxation?

Answer 18

Trunk: Lateral flexion to the weak side
Scapula: downward rotation
Humerus: abd, IR. Humeral head is below the inferior lip of the fossa
Distal Extremity Alignment: elbow extended and pronated
Movement Available: scapular elevation.

Question 19

Anterior Subluxation?

Answer 19

Trunk: increased extension, lateral rotation of the rib cage.
Scapula: downward rotation and elevated
Humerus: hyperextension, IR.
Humeral head inferior to the fossa
Distal Extremity Alignment: Elbow is flexed, pronated or supinated
Movement Available: Shoulder elevation, humeral IR, arm hyper-extension with elbow flexion

Question 20

Superior Subluxation?

Answer 20

Trunk: flexion/extension of the rib cage
Scapula: elevated and abd
Humerus: IR and abd
Humeral Head: under the coracoid process
Distal Extremity Alignment: Supinated with CMC flexed
Movement Available: Shoulder abd, elevation, IR. Elbow/wrist flexion

Question 21

Where does the therapist palpitate the client for subluxation and what position does the client need to be in?

Answer 21

The subacromial space with the index and middle fingers

Seated with UE unsupported at the side in neutral rotation

Question 22

What is the reason the therapist palpates both shoulders for?

Answer 22

Comparison

Question 23

What do the rotator cuff and bicipital tendon provide in the shoulder griddle?

Answer 23

Serves to guide and lead the movement of the shoulder

Provides strength for ROM and supports the head of humerus to be in glenoid fossa.

Question 24

What does adhesive capsulitis results from?

Answer 24

Immobilization, synovitis, or metabolic changes in the joints tissue

Question 25

What is important for treatment when it comes to frozen shoulder?

Answer 25

Early PROM and correct positioning.

Question 26

What are typical ROM limitations with a frozen shoulder?

Answer 26

Shoulder pain ER is less than 20 degrees ABD is less than 60 degrees

Question 27

What is the diagnosis criteria for Branchial Plexus Injury?

Answer 27

Flaccidity and atrophy of the supraspinatus, infraspinatus, deltoid, and bicep muscles in the affected UE with increased muscle tone.

Question 28

What are treatment recommendations for Brachial Plexus Injury?

Answer 28

``` Positioning and PROM/AROM Prevent traction Position: shoulder Er 45 degrees, elbow flexed 90 degrees, and forearm in neutral Sling with ambulating DO NOT SLEEP ON Affected side ```

Question 29

Why is it recommended not to sleep on the affected side when it come to brachial plexus injury?

Answer 29

It further compresses the nerve.

Question 30

What is the risk of hemiplegic shoulder pain?

Answer 30

``` Prolonged hospital stay Arm weakness Poor recovery of arm function Poor Recovery of ADL's Lower rates of discharge home. ```

Question 31

Pain with hemiplegic shoulder impacts?

Answer 31

Function and links to depression.

Question 32

Studies have found that shoulder pain associated with hemiplegic shoulder results in?

Answer 32

The subacromial area is pain-producing | The area is prone to trauma without current handling/ROM

Question 33

What should you avoid with hemiplegic shoulder pain syndrome?

Answer 33

Avoid scapula retraction with forwarding flexion

Question 34

What position shoulder the scapula be in during activities when it comes to hemiplegic shoulder pain syndrome?

Answer 34

Protracted with upward rotation

Question 35

Where should be items placed to encouraged scapula protraction and upward rotation?

Answer 35

In front of the patient or below the waist level.

Question 36

DO's for preventing shoulder pain?

Answer 36

Maintain/increase PROM and ER of glenohumeral joint Maintain scapula mobility on the thorax/ribcage Educate pt, family, caregivers of precautions, positioning Educate pt to avoid pain

Question 37

DON'T for preventing shoulder pain?

Answer 37

Avoid PROM/AROM beyond 90 in flex/abd (unless there is upward rotation and ER of scapula) Avoid dangling of affected UE Avoid traction and forced overhead movement during daily tasks. Use overhead pulleys, forced overhead ROM

Question 38

In what activities would you see the overhead movement? and would want to avoid doing to prevent shoulder pain.

Answer 38

Putting deodorant Bathing armpit Overhead pulleys

Question 39

How does CRPS syndrome begin?

Answer 39

With severe pain and progresses to stiffness in the shoulder and pain in the entire extremity

Question 40

CRPS can progress if not treated. Progress to what?

Answer 40

Frozen shoulder and permanent hand deformities

Question 41

What are the risk factors associated with CRPS?

Answer 41

Sublaxation Considerable weakness Spasticity Neglect

Question 42

Approximately how many individuals will develop CRPS?

Answer 42

1/4 of stroke.

Question 43

Signs and Symptoms of CRPS?

Answer 43

MCP tenderness with compression. Shoulder: decreased ROM and pain with flexion, adduction, ER Elbow: No complaint Wrist: Pain with ext, dorsal edema, deep palpitation is tender Hand: Dosal edema Digits: Extreme pain with flexion

Question 44

What is the first stage of Shoulder Hand Syndrome (CRPS)

Answer 44

C/c shoulder pain and hand pain, tenderness, and vasomotor changes. Recovery and reveals of symptoms is high

Question 45

What is the second stage of Shoulder Hand Syndrome (CRPS)

Answer 45

Early dystrophy, muscle and skin atrophy, vasospasm, hyperhidrosis, and signs of osteoporosis. Difficult to treat

Question 46

What is the third stage of Shoulder Hand Syndrome (CRPS)

Answer 46

Pain and vasomotor changes are rare, soft tissue dystrophy, contractures, and severe osteoporosis Irreversible at this stage.

Question 47

What is treatment outside of OT that can help with CRPS?

Answer 47

Nerve block | Stellate ganglion block

Question 48

Prevention of SHS/CRPS/RSD in form of proper handling consists of what kind of techniques?

Answer 48

Proper handling of UE = Avoid traction, support UE, prevent, and prolonged singling. Mobilizing the scapula to ensure gliding

Question 49

Who to educate about prevention of the SHS/CRPS/RSD

Answer 49

Client, Family, and caregivers on proper positioning and handling of affected UE. Edema control

Question 50

What is a protocol for PROM via OT in the case of SHS/CRPS/RSD?

Answer 50

``` Shoulder flex/abd only to 90 IR/ER with humerus adducted Respect pain - perform In pain-free range only Fingers: move joint at a time Felx w/ CMC supported in neutral Exten w/ CMC supported in flex ```

Question 51

What is a protocol for PROM via patient in case of SHS/CRPS/RSD

Answer 51

Do not range affected shoulder w/ intact UE Shoulder AROM below 90 Yes but not >90 AROM IR/ER w/ humerus in add PROM of the elbow, forearm, wrist OK in pain-free range only. Do not range digits w/ intact UE

Question 52

What are the Pros of the application of supports?

Answer 52

Protect client from injury during transfers Allows the freedom for the therapist to assist with trunk control. May prevent soft tissue stretching Prevents prolonged dangling of the UE May relieve pressure on the brachial plexus Supports weight of arm

Question 53

What are the Cons of the application of supports?

Answer 53

May contribute to neglect and learned nonuse May hold UE in shorted position Fosters dependence and passive positioning May initiate Shoulder hand syndrome Predispose for shoulder pain Do not reduce subluxation Prevents reciprocal arm swing during walking Blocks sensory input Prevents balance reaction of the UE Malaligned scapula