UE Hemiparesis

Question 1

When does shoulder subluxation occur

Answer 1

Flaccid stage, can worsen with continued flaccidity or transition to spasticity
(Scapula tilts downward)

Question 2

What muscle when flaccid changes scapula normal alignment into downward rotation, causing glenoid fossa to orient vertically inferior and humoral subluxation inferiorly?

Answer 2

Supraspinatus
*multifidus, pecs pull on humerus into internal rotation

Question 3

What muscles when spastic cause scapular downward rotation and lead to shoulder subluxation?

Answer 3

-lats
-rhomboids, levator, upper trap may be insufficient in tone

Question 4

What is causing shoulder pain, since there is no direct correlation between subluxation and pain?

Answer 4

Impingement
Mm strains
Ligaments and nerves that are stretched
Brachial plexus injury

Question 5

What external support was the most ineffective way to treat shoulder subluxation (reduced percent of subluxation the least)

Answer 5

Hook hemi harness

Question 6

What are issues with the arm trough?
What are issues with the lap tray?

Answer 6

Arm trough: attached to armrest, may have issues with edema, can overcorrect
Lap board: 233% correction, can way overcorrect

Question 7

What is the issue with the sling, even though it was effective in the analysis of reducing subluxation?

Answer 7

The sling hides the arm away from the person and holds it in resting synergy

Question 8

What can be used to strengthen muscles or act as a temporary/semi-permanent orthosis?

Answer 8

Shoulder subluxation protocol of FES/NMES

*systematic review stated they are helpful acutely
*if patients didn’t recover after 6 weeks, they would subluxation after

Question 9

What is shoulder hand syndrome?

Answer 9

Circulation pumps in axilla or hand stop working (arterial, venous, lymph), causing PAIN AND SWELLING due to immobility

Question 10

What can we do as PTs to treat shoulder hand syndrome? Or prevent it?

Answer 10

AROM and PROM
(Edema in MCP/PIPs is the first symptom, causing stiffness in flexion)

Question 11

The skin in shoulder-hand syndrome looks _____ and edema turns into ____.
What follows shoulder hand syndrome? 3 corresponding diseases

Answer 11

Skin: shiny, atrophied
Edema: turns into scar tissue
Disease: Osteoporosis, CRPS, frozen shoulder/hand/fingers

Question 12

___% of people show first signs of shoulder hand syndrome within 1-3 months after CVA

Answer 12

65% of people with SHS
AFTER ACUTE CARE (home health, outpatient, inpatient, SNF)

Question 13

What are conservative treatments for shoulder hand syndrome?

Answer 13

1. PROM
2. ELEVATION OF UE
3. Compression garments/bandages with seams outside
4. Massage: distal to prox
5. NMES

No conservative: stellate chemical blocks for pain by anesthesiologist