Shoulder complications are one of the common complications after stroke, mainly including shoulder pain, shoulder subluxation, and shoulder-hand syndrome, which are described below.
I. Shoulder joint subluxation
Shoulder subluxation is a common complication in the early stage of stroke, mostly occurring within 3 weeks of stroke, and has a great impact on the recovery of upper limb function. The reason for shoulder subluxation in stroke patients is that in the early post-stroke period, the upper limbs are paralyzed to varying degrees, the stability of the shoulder joint is reduced, the muscles around the shoulder joint on the hemiplegic side are hypotonic, and the muscles around the shoulder joint that maintain the normal anatomical position of the shoulder joint are relaxed, which reduces the strength of the stabilizing mechanism that holds the shoulder joint in place and causes the shoulder joint to fall out of its normal position in the joint socket.
Treatment methods for shoulder joint subluxation.
1.Correct the posture of the scapula and pay attention to the placement of the good limb position.
2.Correct the position of the scapula and resist scapular retraction: Bobath type hand grip, extend both upper limbs to fully lift up, repeatedly, both in lying and sitting position.
3.Activate the scapular girdle: let the scapula move upward, outward and forward.
4.Stimulate the tension and activity of the muscle groups around the shoulder joint that play a stabilizing role.
5.Passive movement of the painless range of the shoulder joint to maintain the normal range of motion of the shoulder joint.
II. Shoulder pain
Shoulder pain is one of the common and serious complications after stroke, mostly occurring long after the onset of stroke or even months later, with an incidence of 84%. It not only brings physical and mental pain to patients, but also greatly affects their further recovery. There are many causes of shoulder pain, but it is generally believed that it is mainly due to the disruption of the normal mechanism of shoulder joint movement by muscle spasm and improper handling of the affected shoulder, resulting in disruption of the rhythm of the acromioclavicular joint necessary for shoulder abduction, causing friction and compression between the humeral head, rostral shoulder ligament and soft tissues, thus stimulating the highly dense neuroreceptors in the soft tissues.
Treatment should be directed at the pathogenesis of shoulder pain after hemiplegia using nerve promotion techniques to correct the sinking and retraction of the scapula and the internal rotation and internal retraction of the humerus to reduce the spasm of the shoulder girdle muscle. Attention should be paid to correcting the patient’s sitting and lying position and performing passive and voluntary movements of the affected limbs; at the same time, effective anti-spasticity activities should also be implemented by the therapist to gradually restore the balance of tension between the various groups of muscles around the shoulder and promote the coordination and synchronization of movements between the scapula and humerus, so as to achieve a significant improvement of the spasticity of the shoulder joint. In addition, pain control drugs can be used to control pain, and physiotherapy such as ultrasound and ultrashort wave can be used locally for comprehensive treatment.
Shoulder-hand syndrome
Shoulder-hand syndrome is a common post-stroke complication, often occurring within 1 to 3 months after stroke. The pathogenesis is still unclear, but it is generally thought to be related to reflex sympathetic dystrophy, and some people think it is related to impaired venous return due to mechanical action. The manifestations are: sudden onset of shoulder pain, limited movement, hand pain and edema; later on, hand muscle atrophy, finger contracture deformity, and even permanent loss of motor function of the affected hand. Commonly used prevention and treatment methods are.
1, the correct placement of the affected limb: the affected limb will be elevated to prevent the affected hand from prolonged drooping position; maintain the wrist joint in the dorsal extension position, can be used to fix the wrist joint in the upturned splint. When lying down, put the upper limb flat, raise the distal end flush with the heart, release the fingers, half clenched empty fist, can place a round object in the palm of the hand. This posture can promote the return of venous blood flow.
2, centripetal compression winding: that is, a long cloth band about 1 to 2 mm thick, the affected limb fingers, palm, back of the hand for centripetal winding to the wrist joint above, and then immediately remove the winding thread. Repeatedly, it can reduce edema and promote the self-regulation function of peripheral vasoconstriction and diastole.
3.Ice therapy: Immerse the affected hand in ice water mixture for 3 times in a row, with a short interval in between, this method can reduce swelling, relieve pain and antispasmodic. However, care should be taken to avoid frostbite and increased blood pressure.
4, alternating hot and cold water method: that is, first soak the affected hand in cold water for 5 to 10 min, and then soak in warm water for 10 to 15 minutes, three times a day. To promote the ability of peripheral vasoconstriction-diastole regulation.
5.Active exercise: If possible, practice active activities, such as training the patient to rotate the affected shoulder, flex and extend the elbow and wrist joints, but in appropriate amounts and to the extent that the patient feels that he or she can bear the sensation, avoiding excessive movement to artificially damage the muscles and tendons.
6.Passive movement: The health care personnel should help to move the affected limb and comply with the activities of the joints of shoulder, elbow and wrist, and the activities should be gentle so as not to produce pain. Start training at the early stage of stroke, 24-48h after stroke, the earlier the better, to prevent shoulder pain and maintain the mobility of each joint.
7. In addition, acupuncture, herbal medicine, massage and physical therapy can be applied to treat shoulder-hand syndrome in an integrated way.