1.Treatment principles
(1) Correct the position of the joint pelvis by correcting the position of the scapula in order to restore the original locking mechanism of the shoulder.
(2) Reduce the unfavorable tension of the nervous system so that the shoulder joint can be reset and protective muscle activity can be restored.
(3) Stimulate the activity and tone of the stabilizing muscles around the shoulder joint.
(4) Maintain a painless full range of passive motion of the shoulder joint without damaging the shoulder joint and its surrounding structures.
(5) Protect the injury-prone shoulder joint in daily treatment.
2.Treatment measures
(1) Correct the posture of the scapula
a.Good limb position placement.
① Supine position, with the affected side scapular band extended forward, elbow joint extended, forearm rotated back, wrist joint and fingers extended.
(ii) In the affected side lying position, the affected shoulder is extended anteriorly with <90° forward flexion, elbow extension and forearm rotation.
(iii) In the healthy-side recumbent position, the affected shoulder and upper limb are fully extended anteriorly, with the elbow joint extended.
(iv) In sitting position, a flat table is placed in front of the affected limb and the affected limb is held up.
⑤When standing or walking, the therapist should fully protect the affected limb to avoid natural drooping.
b.Turn over to the affected side: resist scapular retraction.
c. Bobath-type grip: extend both upper limbs to fully lift them up, repeatedly, both in the prone and sitting positions. Xuanwu Hospital generally emphasizes that patients with shoulder subluxation should only perform Bobath grip supination training in the lying position, because this position is the only way to keep the shoulder joint basically in the normal joint position, and it is generally not recommended to perform it in the sitting and standing position, nor is it recommended to perform training such as abrasive table to prevent sports damage to the shoulder joint and cause secondary shoulder pain.
d.Activate the scapular band: let the scapula move upward, outward and forward. For shrugging exercise, instruct the patient to shrug the affected shoulder joint as a whole upwards, reciprocally.
e. Application of shoulder sling The shoulder sling should be applied appropriately in the early stage to correct the shoulder joint dislocation, and should prevent excessive stretching of the shoulder joint. Pay attention to the selection of the correct shoulder belt to prevent reinforcement of the hemiplegic pattern.
(2) Stimulate the tone and activity of the stabilizing muscles around the shoulder
(1) Pull reflex: The therapist supports the affected arm with one hand and extends it forward, while the other hand gently taps the humeral head upward. The pull reflex of the elbow increases the tone and activity of the deltoid and supraspinatus muscles.
②Rapid stimulation: Do rapid friction or stimulate with ice on the infraspinatus, deltoid and triceps from near to far.
③Weight-bearing on the affected side: sitting position with the affected elbow extended and wrist dorsiflexed, the affected hand placed slightly lateral to the level of the sitting hip and the torso tilted to the affected side. [The patient takes a sitting position, the affected upper limb is externally rotated, extended, elbow extended, forearm rotated back, wrist and fingers extended, and supported on the bed for weight-bearing] Weight-bearing training of the affected upper limb is performed by straightening the elbow joint, dorsiflexing the wrist joint, placing the affected hand on the slightly lateral side of the sitting hip level, and then tilting the torso to the affected side, using the patient’s body weight to put pressure and weight on the joints of the affected limb, in order to reflexively stimulate the shoulder joint stabilizing muscles. Pay attention to assisting the patient to protect the correct position of the shoulder joint.
The therapist places one hand at the elbow joint and holds the affected hand with the other hand and applies pressure to the shoulder joint along the longitudinal axis of the upper limb.