Shoulder Subluxation: Effective Treatment Approaches
Transcript of Shoulder Subluxation: Effective Treatment Approaches
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Shoulder Subluxation:
Effective Treatment
ApproachesCindy Erb, OTD, MSH, OTR/L, C/NDT, CLT
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Shoulder ReviewWhat do you know?
A-C Joint: upper scap/clavicle (shrug)
Gelnohumeral Joint: glenoid fossa of
scap/humerus (all shoulder motions)
Sternoclavicular Joint: clavicle/sternum
(shrug, stabilize)
Scapula 2:1
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Shoulder Review
MM: move/stabilize
Flexion: pec major, deltoid (ant),
coracobrachialis.
Abduction: deltoid, supraspinatus.
Adduction: subscapularis, pec major,
weight of arm.
ER: infraspinatus, teres minor
IR: subscapularis, latissimus dorsi, teres
major, pec major, deltoid (ant)
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Shoulder Review “SITS”Muscles of the RTC
IR: Subscapularis
ER: Infraspinatus, Teres Minor
ABD: Supraspinatus
ADD: Subscapularis
“Raise & Rotate”
Stabilize-Proximal Stability/Distal Mobility
Depress the humeral head against the glenoid. (Subscapularis)(Tear: humeral head can migrate upward because of opposing force of deltoid.)
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Shoulder Review
Scapular Stability: trapezius, serratus anterior, rhomboid.
Scapular Upward Rotation: trapezius, serratus anterior.
Scapular Retraction: trapezius, rhomboids.
Postural Support: levator scapulae, upper trap.
Overhead Stability: coracobrachialis.
Scapular Rotation: trapezius, serratus anterior, rhomboid,
levator scapulae
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Assessment
pain, instability, stiffness, locking, catching, swelling.
Dislocation, Arthritis, Adhesive Capsulitis: stiffness, loss of motion.
G-H Instability(anterior): pain with ‘throwing’.
G-H Instability (multi-directional): generalized joint laxity.
Labral Disorder: pain or ‘clicking’ with overhead motion.
Impingement: Nighttime shoulder pain.
Scapular Winging: serratus anterior, trapezius
Neck pain and pain that radiates BELOW the elbow are often cervical spine disorder.
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Shoulder Subluxation
Mobility of shoulder makes it vulnerable for injury
Partial dislocation
tone
pain
swelling
weakness
Numbness
Separation of the joint as a result of paralysis or weakness of the rotator cuff muscles &
spasticity of the scapular muscles
Absence of normal scapular-humeral rhythm
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Sensory-Motor Premise to Recovery
Motor control is the ability to make dynamic postural adjustments and direct
body and limb movement in purposeful activity.
Components necessary include:
normal muscle tone
normal postural tone and normal postural reflex mechanisms
selective movement/coordination.
Postural alignment
Proprioception/kinesthesia
Proprioception, which overlaps with kinesthetic awareness, provides a sense of body symmetry, or necessary balance and positioning between
body parts, and specifically refers to a sense of joint position.
The cerebral cortex, basal ganglia, and cerebellum work together to make
motor control possible.
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OT Tx Considerations: Subluxation
Alignment/Positioning
Tone
Weight Bearing-Approximation
Proprioception/Dynamics
Normal Movement Patterns
Repetition/Time
Consideration of Pain
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What is making Gravity NOT
Work?
Continual
Assessment
of Key
Points of
Control
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Alignment, ROM, Static vs Dynamic
Codman’s Exercise/Pendulum vs.
Gravity Eliminated
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Weight Bearing
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Dynamics Where There Isn’t Any
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Recognize the Sequence of Recovery
…for all diagnoses!
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UE Ranger
Magic!
Fluid,
resistant-free
patterned
movement
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Mobile Arm Support
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Segmental Reach/Eye-Hand
Coordination/Posture/Wt Shift
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Scapula-Beautiful Symmetry
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Sustained Suspension w/Tension
Sensory-Motor Benefits of Dynamics
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Treatment
Dynamic Positioning/Antispasticity Ball Splint
Alignment/Minimal use of W/C
Passive Patterned Motion through all planes
Weightbearing (Approximation/Traction)
Movement on/off of Affected UE/Reach Patterns
Normal Movement Patterns
Giv-Mohr Sling
UE Ranger
Kinesiotape
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Slings: Protection, Injury Prevention,
Pain Reduction, Ambulation
Soft tissue can become overstretched from the effects of
gravity and improper handling of the arm. Stroke patients
who have their arm unsupported and/or handled
inappropriately (i.e. pulling on the arm) are at higher risk
for traction neuropathy and injury.
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Giv-Mohr Sling
https://www.givmohrsling.com/research.htm#Dec05
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Kinesiotape
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Antispasticity Ball Splint
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