Treatment of shoulder subluxation

- Jun 12, 2020-

Treatment of shoulder subluxation


For the treatment of shoulder subluxation, we have to mention the early protection of shoulder subluxation, because early protection can effectively prevent the occurrence of shoulder subluxation.

 

Prevention and protection

1. Positioning:

The study found that the upper limbs of patients with cerebrovascular accidents were placed in good limb positions early and adhered to the whole process, which can effectively prevent the occurrence of shoulder subluxation.

(1) In the supine position, the patient's bilateral shoulder joints are fixed on the pillow to prevent the shoulder joints from retreating. The upper limbs of the affected side should maintain a certain angle (greater than 45 degrees) with the trunk, and the upper limbs should be placed on the cushion.

(2) When lying on the healthy side, the torso leans forward slightly, the shoulder joint on the affected side stretches forward, and the upper extremity rests on the pillow at a 100-degree angle to the torso.

(3) In the lying position of the affected side, the torso slightly receded, the shoulder joint of the affected side was fully extended and rotated internally, and the upper limb of the affected side was at a 90-degree angle to the trunk.

2. In the process of ordinary transfer and posture change, the family members should pay attention to protect the shoulder joints of the patient and avoid pulling the affected limbs when the patient sits up.

When sitting in a wheelchair, the affected limb should be supported to avoid sagging on the side. When the patient rolls over to the healthy side, it is necessary to protect the affected limb and avoid the situation behind the back. When the doctor or therapist checks the patient's shoulder joint mobility, if the arm is lifted from the distal end without supporting the proximal humerus head, the vulnerable structure may also be damaged.

3. Early use of shoulder sling can reduce the occurrence of shoulder subluxation.

On the basis of conventional rehabilitation treatment, the addition of an inflatable shoulder strap to treat the subluxation of the shoulder joint after hemiplegia can reduce the occurrence of shoulder pain and reduce the degree of shoulder pain, which is conducive to improving the motor function of the upper limbs of hemiplegia. Reset rate. In the clinical treatment, it was found that many family members will not wear it correctly, and our therapist should teach the family members to wear it correctly. Ask the patient to wear it in the sitting position and in the upright position, but not in the lying position.

4. Early joint weight-bearing

To study the clinical effect of early joint weight-bearing to prevent shoulder subluxation after stroke, it was found that early joint weight-bearing can effectively prevent the occurrence and development of shoulder subluxation, and can significantly improve the upper limb motor function of the affected side.

5. Low frequency electrical stimulation

Stimulation of shoulder joint muscles by low-frequency electricity, especially deltoid and supraspinatus muscles, can cause them to produce movement, but early electrical stimulation can prevent shoulder joint subluxation; if the shoulder joint subluxation has occurred, then give Electrical stimulation therapy has little effect.

6. When hemiplegic patients are in the period of hemiplegia, they should pay attention to reducing the passive activity of the shoulder joint and the frequency of passive activity.

Do not flex forward more than 120 degrees, because the normal scapula chest arm has a 60-degree range of motion, and the shoulder-brachial joint has a 120-degree range of motion. If the scapula is fixed, the upper arm can only be actively raised to 90 degrees and passively raised to 120 degrees When the scapula activity is lost, the shoulder activity should be at least 1/3 less than the normal activity. Due to the imbalance of shoulder brachial rhythm in patients with paraplegia, impaired sensory side of hemiplegia, excessive passive activity may damage the shoulder joint and cause subluxation of the shoulder joint. When the patient performs the Bobath handshake training on the bed, they should move slowly, and should not use too much force or violent force, just lift it directly above the forehead.

 

Treatment

1. Correct the posture of the scapula

By loosening the scapula, after restraining the high tension of the muscle that makes the scapula rotate downward and backward, the patient is taught to lift the shoulder forward, that is, toward the nose. By restoring the normal posture of the scapula, the passive locking mechanism of the shoulder joint is restored.

2. Reduce nervous system tension to correct shoulder subluxation

When the tension of the nervous system causes subluxation of the shoulder joint, in this case, the patient's head is pulled toward the affected side to lift the scapula, which can relax the nervous system at a different starting position, and gradually increase the neck in the sitting position. The degree of lateral flexion restores the stretch of the nerve structure that caused the shoulder blade to lift excessively.

3. Low-frequency modulation medium frequency electrical stimulation

Low-frequency modulation medium-frequency electricity has the characteristics of both low-frequency and medium-frequency electricity, and promotes the recovery and reconstruction of central nervous function through the body reflex mechanism, and restores the motor function of hemiplegic limbs. The use of low-frequency modulated intermediate frequency electrical stimulation of the stable muscles around the shoulder joint can increase the reduction rate of shoulder subluxation in the early stage of stroke.

4. Biofeedback therapy

Studies have shown that the condition of shoulder joint subluxation is significantly reduced, which has greatly improved the upper limb motor function. At the same time, clinical observations have found that patients with shoulder pain, abnormal sensation, upper limb edema and other symptoms have also been reduced to varying degrees.

5. Functional electrical stimulation

FES stimulated the affected shoulder sleeve and deltoid muscle. Conclusion FES can significantly improve the reduction rate of shoulder subluxation in the short term, but there is no significant difference between the long-term effect and shoulder support treatment.

6. Acupuncture

Acupuncture can improve the condition of subluxation of the shoulder joint, study the front of the shoulder, shoulder lift, arm brace, shoulder middle, shoulder zhen, Fuyu, shoulder outside Shu, Bingfeng, electroacupuncture intermittent wave combined with rehabilitation training to treat the brain The effect of subluxation of shoulder joint after stroke is better than that of electroacupuncture sparse wave and continuous wave. It can effectively improve subluxation of shoulder joint and promote functional recovery of shoulder joint.

7. PNF

The mechanism of treatment of shoulder subluxation is not very clear, and some studies have shown that it may be related to the short-term proprioception stimulation that can increase the excitability of the target muscle cortex representative area. During the treatment, targeted training of the affected side scapular belt pattern and the affected side upper extremity combined mode was carried out, including shoulder blade belt forward extension, shoulder blade belt retraction, shoulder blade belt forward retraction, shoulder blade belt extension, unilateral D2 flexion mode of upper extremity, bilateral upper extremity D2 flexion mode. It is clinically found that PNF has a significant effect on hemiplegia patients in the early stage, but the long-term effect is not obvious.

8. Muscle training

Shoulder subluxation after stroke is mainly related to muscle tone and muscle strength in patients with hemiplegia, which generally occurs in the early relaxation stage of stroke. It is especially important for patients with shoulder subluxation. It can promote the recovery of muscle strength and muscle tension by quickly tapping and squeezing the stabilizing muscles of the shoulder joint, quickly rubbing the extensor muscles from the proximal end to the distal end, and the Rood technology.

9. Tie and paste

The shoulder and elbow taping method has a good immediate effect on shoulder subluxation of stroke patients, and can provide a new treatment method for early stroke patients to correct shoulder subluxation.

10. Occupational therapy

On the basis of exercise therapy, teach patients the correct method of using the affected upper limbs in daily activities such as dressing and transferring. Together with the operation therapy such as pushing rollers and frosting plates, the occurrence of shoulder subluxation will be significantly reduced, which has the function of recovering the upper limbs. Significance.

 

Shoulder Subluxation Treatment Follow

By correcting the position of the scapula, and then the position of the glenoid, to restore the natural noose mechanism of the shoulder. Stimulate the activity of the muscles around the shoulder joint that stabilize or increase their tension. Without damaging the shoulder joint and surrounding tissues, it maintains the painless passive range of motion of the entire joint.