Hemiplegic Shoulder Pain in Shoulder Subluxation after Stroke: Associated with Range of Motion Limitation
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Abstract:
correlate with magnetic resonance (MR) arthrography findings such as rotator cuff tendon tear except rotator cuff atrophy.Keywords:
Stroke
Subluxation
Objective: The primary objective of the study was to evaluate the effect of California tri-pull taping (CTPT) method on post stroke shoulder subluxation, pain, active range of motion and upper limb functional recovery. Design: Pretest post test design. Setting: Study was conducted ininpatient and outpatient department of MM hospital Mullana- Ambala. Participants: 10 subjects with post stroke shoulder subluxation were included into the study. (7 male , 3 female). Intervention: For taping, two types of tape was used, cotton pre-tape and rigid post-tape. Tape was applied to subjects for thrice a week, for six weeks and conventional neuro rehabilitation programmewas also given to the subjects, five days a week for six weeks. Main outcome measures: Pre, and post assessment scores were taken from each subject by using, Digital Vernier caliper, visual analogue scale (VAS), Goniometer, and Fuglmeyer scale (FUG). Results: The CTPT method produced significant reduction on inferior subluxation from pre intervention to post intervention, pain. There was also significant improvement of AROM, and FUG. Conclusion: This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder. The main limitation of the study was, small sample size and no control group was used.
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Subluxation
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Sixteen patients with seropositive rheumatoid arthritis were operated on for subaxial subluxations. Four of the patients had slight, but progressive, tetraparesis, and 5 had severe or total tetraparesis; they were operated on 1–4 months after the first signs. Seven patients were treated for severe neck and shoulder pain. Nine patients had subluxation at the C3–4 level, the most common site, and 3 patients also had an atlantoaxial subluxation. Patients with cord compression were treated with posterior laminectomies and fusions that relieved the tetraparesis. Two patients died during the early postoperative period: 1 of a cardiac infarction and the other of pneumonia. During 4 (1.5–9) years' follow-up, 3 patients had new subluxations at other levels.
Tetraparesis
Subluxation
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The effects of surgical treatment for cervical spine lesions were clinically evaluated in 8 patients with Rheumatoid Arthritis (RA); mutilans type. Six patients complained of pain in the nape and occipital region, and myelopathy was noted in 3 patients. Upper cervical spine lesions were shown in 7 cases and lower in 4 cases. We performed posterior spinal fusion (CO-C2: 5 cases, C1-C2: 2 cases, below C3: 4 cases) for all patients. Posterior decompression was accompanied with posterior spinal fusion in 2 of these cases who had subaxial subluxation with cervical stenosis. Occipitocervical fusion was carried out in 1 patient with atlanto-axial subluxation in the upper cervical spine because vertical subluxation was progressing. After operation immobilization was continued using a halo-vest for an average period of 11 weeks in 7 patients with upper cervical lesions. Solid union was demonstrated radiographically in 7 except 1 patient who had died 8 months after surgery. The condition of all patients improved on early follow-up. Understanding the severity of mutilans RA, could be a better determinant for choosing the appropriate surgical treatment.
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BACKGROUND
The rehabilitation intervention for upper extremity fracture varies from shoulder to finger, obtained from physical modalities and exercise. Physical modality and exercise rehabilitation intervention effectively reduce pain, increase range of motion (ROM), hand function and improve quality of life. This systematic review aims to synthesize current scientific knowledge on rehabilitative interventions with a specific focus on upper extremity fractures and the effect of all interventions on the patient.
METHODS
Three scholarly databases (PubMed, Google Scholar, Science Direct) were systematically searched. Literature published before 10 January 2022 focused on upper extremity fracture and rehabilitation treatment patients. Quality assessment was completed with CEBM tools by Oxford University. For PICO, The Population was upper extremity fractures, and the intervention was rehabilitation intervention, both physical modality and exercise. The comparation was other rehabilitation interventions or without rehabilitation, and the outcome in this study were measured with the visual analogue scale (VAS), ROM, hand function, and quality of life (QoL).
RESULTS
Eight studies were included in this review among 18.326 reference titles founded and screened. All of the studies had various sample sizes followed by bias analysis with CEBM tools. Rehabilitation for elbow fracture was dynamic fixation using rigid tape and proprioceptive neuromuscular facilitation stretching. Rehabilitation for distal radius fracture was scapular exercise, graded motor imagery, hot pack on hand volume, illusory kinesthesia, and wrist exercise. These interventions can reduce the pain, improve strength, range of motion, hand function and quality of life in upper extremity fracture patients.
CONCLUSIONS
Exercise and physical modality rehabilitation intervention have proven to reduce pain, improve strength, range of motion, hand function and quality of life in upper extremity fracture patients.
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Twenty-eight rheumatoid arthritis patients with symptomatic subluxation of the cervical spine had 34 operative procedures in the period from 1983 to 1989. Two distinct groups are noted with regard to management and prognosis. The treatment of isolated atlantoaxial instability has been straightforward and the morbidity low. Subaxial instability and combined atlantoaxial and subaxial instability were more difficult to manage: The incidence of preoperative neurologic deficit was higher and the operative technique more demanding. There have been two late deaths of quadriparesis. Half of the other patients were ambulant and independent. The halo jacket has been used to reduce subaxial subluxation and neurologic deficit before surgery. Both anterior and posterior approaches have been successfully employed.
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Proprioception
Facilitation
Subluxation
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I evaluated the effectiveness of the California Tri-Pull Taping method for clients with poststroke inferior shoulder subluxation of the glenohumeral joint.Ten participants were followed for 9 wk using an interrupted time series quasi-experimental single-subject ABA design to examine shoulder pain, activities of daily living (ADL) function, active range of motion, tape comfort, and subluxation.The California Tri-Pull Taping method decreased inferior subluxation significantly from baseline to intervention but not at postintervention. Active range of motion was significantly increased in shoulder flexion and abduction between the baseline and intervention and the intervention and postintervention phases. Functional ADL scores were significant. The taping was reported to be comfortable. No significant difference in pain was found.This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder that warrants further research.
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Hemiplegia in the upper limb and shoulder complex is a common secondary impairment resulting from a cerebrovascular event; evidence-based intervention is required for effective treatment. Prior to addressing shoulder movement, biomechanical alignment of the pelvis and trunk must first be assessed. Extreme care must be taken when completing passive range of motion with the hemiplegic shoulder; motion should not exceed beyond 90° of shoulder flexion and abduction without scapular upward rotation and humeral head external rotation. It is recommended that the use of slings with upper limb hemiplegia be limited. A subluxation of the shoulder can be treated with surface neuromuscular electrical stimulation if the recommended protocol of 6 hours daily, 5 days a week, for 6 weeks is utilized. Taping/strapping for a subluxation has conflicting evidence for reducing the development of hemiplegic shoulder pain, and it does not improve upper limb function or range of motion.
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The purpose of this study was to determine effects of rehabilitation exercise and kinesio taping on muscle activity, a working range of motion, and pain in the shoulder joint.The study is evidenced by rehabilitation program for judo patients with subluxation of the shoulder joint, who underwent kinesio taping and rehabilitation exercise for 8 weeks.In case of internal rotation, kinesio taping showed significant interaction with supraspinatus tendon.For deltoid and latissimus dorsi, however, there was increase in muscle activity with no significance.In external rotation, while the taping did not appeared to be interactive with supraspinatus tendon, there was increase in muscle activity and noteworthy interactions with deltoid and latissimus dorsi.Statistically significant result was shown in joint working range of motion, abduction, and extension with increase in ROM after kinesio taping.Self-awareness of pain was decreased in kinesio taping group, but not significant.The study showed positive effects on both rehabilitation exercise group and kinesio taping group of judo subluxation patients, especially the group with two methods combined together.In other words, mix of the two programs offers the best improvement for subluxation patients.It is suggestive that more specified experiments with isokinetic equipments should be done to research myofunction restoration in depth.
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