Can some treatment principles for adhesive capsulitis and shoulder impingement be applied to hemiplegia?
Answer
As with adhesive capsulitis, the humeral head is often not in a good position in a client with hemiplegia. Due to instability, abnormal tone and decreased muscle function, the shoulder often is dropped out of position. This pulls the scapula into downward rotation. Some of the principles that we discussed such as taping the scapula in a upward rotation may help bring the humeral head into better approximation with the shoulder girdle. You can also have your patient lay down with a towel under the scapula and work on internal and external rotation to begin to wake up the rotator cuff muscles. Supportive figure 8 type slings may help with positioning as well.
Ann Porretto-Loehrke, DPT, PT, CHT, COMT
Ann Porretto-Loehrke is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through the International Academy of Orthopedic Medicine-United States (IAOM-US). She earned a post-professional Doctorate in Physical Therapy (DPT) degree from Drexel University with a specialty in hand and upper quarter rehabilitation. Ann co-authored the chapter “Therapist’s Management of Other Nerve Compressions About the Elbow and Wrist” in the most recent edition of Rehabilitation of the Hand & Upper Extremity. She is the therapy manager at the Hand to Shoulder Center of Wisconsin, located in Appleton, Wisconsin. Ann is also the lead instructor for the Hand & Upper Extremity Track through IAOM, a manual therapy track designed specifically for hand therapists. She is a dynamic, passionate instructor who loves teaching and providing patient care.
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