strapping in hemiplegic shoulders

[sarahlmorleypot]

Has anyone used any strapping techniques to help maintain glenohumeral alignment in hemi arms? Any recommendations of dos and don'ts??

[NARSTR]

I've tried several methods, none of which appears to alter the subluxation 'gap', clinically. Cannot say radiologically. A collar and cuff is barely useful and probably causes more problems than solves. If you can obtain compliance- hereis what I do:
Request the sling is ONLY for transfers. It must come off and the arm positioned if sitting and lying.
Make FOUR loops in the sling. Two for above and below the elbow, and two for wrist and hand support. This way at least the support to the head of humerus is directly where it should be - under the glenoid cavity, and kept there by the loop above the elbow.

[perfphysio]

the interesting thing about the hemi subluxation is the fact that it goes along with internal humeral rotation. Anatomically the superior ligamentous structures of the glenohumeral join unwind into internal rotation and tighten the gap in external rotation. Although not yet researched the addition of stimulation to the posterior rotator cuff early post stroke or the user of biofeedback training for the same region, may enable to patient to minimise their subluation voluntarily without the need for strapping. Anatomically the capsule of the GH joint has several centimeters of subluxation available without muscle influence, so any strapping that is made should try to assist the muscular activity. Best of luck :-)

[moizbohra]

hi sarah!
even i m facing the same prob in my hemi patients.
with them i have found that they get proper reduction of shoulder only when the muscle is contracting but as soon as the tone is zero i e if the deltoid relaxes the humeral head will be out again. but only thing which is to be taken care is to prevent further lengthening of joint capsule, ligaments and muscles arround. Use isometric holding i e hold relax and rhythmic stabilisation beginning from mid ranges to extremes of ranges. Also try manual resistance or weights to make use of gamma bias. All the very best!
Moiz Bohra

[moizbohra]

hi sarah!
even i m facing the same prob in my hemi patients.
with them i have found that they get proper reduction of shoulder only when the muscle is contracting but as soon as the tone is zero i e if the deltoid relaxes the humeral head will be out again. but only thing which is to be taken care is to prevent further lengthening of joint capsule, ligaments and muscles arround. Use isometric holding i e hold relax and rhythmic stabilisation beginning from mid ranges to extremes of ranges. Also try manual resistance or weights to make use of gamma bias. All the very best!
Moiz Bohra

[stefanja]

Research doesn't show strapping or splints to be effective. FES to the posterior deltoid and supraspinatus (if I remember correctly) has been shown to reduce subluxation but has no effect on pain relief or function

[meg55]

Originally Posted by stefanja

Research doesn't show strapping or splints to be effective. FES to the posterior deltoid and supraspinatus (if I remember correctly) has been shown to reduce subluxation but has no effect on pain relief or function

I have attached (at least tried too!) a very good evidence-based review of painful shoulder after stroke, giving an overview of the condition and the different ways it can be treated. Apparently strapping does relieve pain, but doesn't appear to improve function. Slings don't appear to prevent subluxation either. The only bright side is that some subluxed shoulders aren't painful. Pain seems to be more related to spasticity
In case I haven't managed to attach this doc, it's called The Painful Hemiplegic Shoulder, by Debbi Harley.

[Ankit]

Hi
I just read ur reply for hemi shoulder
even i m having a patient of hemi but there is no subluxation or dislocation but there is no movement in upper extremity so can u tell me something to regain the range in the UE.

Ank