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Physical Disability Intervention II > Week 10 Hemiplegic Shoulder > Flashcards

Week 10 Hemiplegic Shoulder Flashcards

1
Q

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

A

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

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

A

Spinal flexion.

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5
Q

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

A

Anterior abdominal muscles are shortened and posterior are elongated.

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6
Q

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

A

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

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7
Q

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

A

The scapula is flush on the ribcage and upwardly rotated.

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8
Q

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

A

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

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9
Q

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

A

Downward rotation

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10
Q

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

A

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

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11
Q

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

A

Pelvic/trunk, ribcage, and scapula alignment.

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12
Q

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

A

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.

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13
Q

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

A

subluxation

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14
Q

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

A

IR which blocks a forearm rotation

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15
Q

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

A

flexion and ulnar deviation (typical stroke)

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16
Q

Intrinsic Atrophy results in?

A

Claw hand.

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17
Q

When is subluxation more common?

A

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

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18
Q

Inferior Subluxation?

A

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.

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19
Q

Anterior Subluxation?

A

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

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20
Q

Superior Subluxation?

A

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

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21
Q

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

A

The subacromial space with the index and middle fingers

Seated with UE unsupported at the side in neutral rotation

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22
Q

What is the reason the therapist palpates both shoulders for?

A

Comparison

23
Q

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

A

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.

24
Q

What does adhesive capsulitis results from?

A

Immobilization, synovitis, or metabolic changes in the joints tissue

25
Q

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

A

Early PROM and correct positioning.

26
Q

What are typical ROM limitations with a frozen shoulder?

A

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

27
Q

What is the diagnosis criteria for Branchial Plexus Injury?

A

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

28
Q

What are treatment recommendations for Brachial Plexus Injury?

A 
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
29
Q

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

A

It further compresses the nerve.

30
Q

What is the risk of hemiplegic shoulder pain?

A 
Prolonged hospital stay 
Arm weakness 
Poor recovery of arm function
Poor Recovery of ADL's 
Lower rates of discharge home.
31
Q

Pain with hemiplegic shoulder impacts?

A

Function and links to depression.

32
Q

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

A

The subacromial area is pain-producing

The area is prone to trauma without current handling/ROM

33
Q

What should you avoid with hemiplegic shoulder pain syndrome?

A

Avoid scapula retraction with forwarding flexion

34
Q

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

A

Protracted with upward rotation

35
Q

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

A

In front of the patient or below the waist level.

36
Q

DO’s for preventing shoulder pain?

A

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

37
Q

DON’T for preventing shoulder pain?

A

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

38
Q

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

A

Putting deodorant
Bathing armpit
Overhead pulleys

39
Q

How does CRPS syndrome begin?

A

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

40
Q

CRPS can progress if not treated. Progress to what?

A

Frozen shoulder and permanent hand deformities

41
Q

What are the risk factors associated with CRPS?

A

Sublaxation
Considerable weakness
Spasticity
Neglect

42
Q

Approximately how many individuals will develop CRPS?

A

1/4 of stroke.

43
Q

Signs and Symptoms of CRPS?

A

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

44
Q

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

A

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

45
Q

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

A

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

46
Q

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

A

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

47
Q

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

A

Nerve block

Stellate ganglion block

48
Q

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

A

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

49
Q

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

A

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

50
Q

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

A 
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
51
Q

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

A

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

52
Q

What are the Pros of the application of supports?

A

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

53
Q

What are the Cons of the application of supports?

A

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

Physical Disability Intervention II (6 decks)

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