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Painful Hemiplegic Shoulder - kio.ac.jp

Module 11. Painful Hemiplegic Shoulder . Robert Teasell MD, Norine Foley MSc, Sanjit K. Bhogal MSc KEY POINTS - Painful Hemiplegic Shoulder .. NSAID .. 4 .. 1. Table of Contents Key Points .. 1. Incidence of Hemiplegic Shoulder pain .. 3. Causes of Hemiplegic Shoulder pain .. 4. Shoulder 6. Pathophysiology .. 6. Scapular Rotation .. 7. pain in Shoulder Subluxation .. 8. Spasticity, Contractures and Hemiplegic Shoulder pain (HSP) .. 12. Spastic Muscle Imbalance .. 13. Frozen or Contracted Shoulder .. 16. Rotator Cuff 18. Functional Impact of Painful Hemiplegic Shoulder .. 18. Management of the Painful Hemiplegic 20. Positioning of the Hemiplegic Shoulder .. 21. Slings and Other Aids .. 22. Strapping the Hemiplegic Shoulder .. 25. Active Therapies in the Hemiplegic Shoulder .. 26. Electrical Stimulation in the Hemiplegic Shoulder .. 28. Surgery as Treatment for Muscle Imbalance .. 35. Botulinum Toxin Injections as Treatment for HSP .. 36. Steroid Injections as Treatment for HSP.

3 11. Painful Hemiplegic Shoulder 痛みのある片麻痺の肩 11.1 Incidence of Hemiplegic Shoulder Pain 片麻痺の肩の痛みの発生 片麻痺に起因する肩の痛みは,血管損傷(例えば,出血性または虚血性脳梗塞)に起因する局所の脳損傷の一

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  Shoulder, Pain, Hemiplegic shoulder pain, Hemiplegic, Hemiplegic shoulder

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Transcription of Painful Hemiplegic Shoulder - kio.ac.jp

1 Module 11. Painful Hemiplegic Shoulder . Robert Teasell MD, Norine Foley MSc, Sanjit K. Bhogal MSc KEY POINTS - Painful Hemiplegic Shoulder .. NSAID .. 4 .. 1. Table of Contents Key Points .. 1. Incidence of Hemiplegic Shoulder pain .. 3. Causes of Hemiplegic Shoulder pain .. 4. Shoulder 6. Pathophysiology .. 6. Scapular Rotation .. 7. pain in Shoulder Subluxation .. 8. Spasticity, Contractures and Hemiplegic Shoulder pain (HSP) .. 12. Spastic Muscle Imbalance .. 13. Frozen or Contracted Shoulder .. 16. Rotator Cuff 18. Functional Impact of Painful Hemiplegic Shoulder .. 18. Management of the Painful Hemiplegic 20. Positioning of the Hemiplegic Shoulder .. 21. Slings and Other Aids .. 22. Strapping the Hemiplegic Shoulder .. 25. Active Therapies in the Hemiplegic Shoulder .. 26. Electrical Stimulation in the Hemiplegic Shoulder .. 28. Surgery as Treatment for Muscle Imbalance .. 35. Botulinum Toxin Injections as Treatment for HSP .. 36. Steroid Injections as Treatment for HSP.

2 39. Aromatherapy/Acupressure Treatment for Shoulder pain .. 41. Massage Therapy .. 42. Subscapular Nerve Block for the Treatment for Shoulder pain .. 43. Summary of the Management of Hemiplegic Shoulder .. 44. Complex Regional pain Syndrome (CRPS) .. 46. Stages and Symptoms of CRPS .. 46. Pathophysiology of CRPS .. 47. Incidence of CRPS .. 47. Diagnostic Tests of CRPS .. 50. Treatment of CRPS .. 51. Pharmacological Treatment of CRPS .. 52. Mirror Imagery as a Treatment for CRPS .. 53. Passive Range of Motion Exercises for the Prevention of CRPS .. 55. Calcitonin for the Prevention of CRPS .. 56. 57. 2. 11. Painful Hemiplegic Shoulder . Incidence of Hemiplegic Shoulder pain . ( ) . 48% 84% . (Najenson et ,Poulin de Courval et al 1990) HSP . (Najenson et ,Poduri 1993) . 2 2-3 (Poduri 1993) Gamble (2002) 52/152(34%) 28% 2 87%. 2 6 80% Lindgren (2007) 416 305 74 (24%) 16 . 4 . Rajarathanam 2007 98 3 . Neer . 10 . Gamble et al. 2000 .. (Risk et ) Lo (2005).

3 1 . 32 16% 4% 50% . 63% 1 34% 2 .. 3. HSP .. Conclusions Regarding the Incidence of Hemiplegic Shoulder pain Following Stroke . 9% 73% . Causes of Hemiplegic Shoulder pain .. (Kaplan 1995) . ( ) . (Crossens-Sills and Schenkman 1985,Moskowitz et ,Savage and Robertson 1982,Shai et al 1984) . (Bloch and Bayer 1978,Braun et ,Fugl-Meyer et al 1975,Crossens-Sills and Schenkman 1985,Hakuno et al 1984,Risk et ) (Braun et al 4. 1981,Caldwell et ,Moskowitz 1969a,1969b) . (Chu et ,Davis et ,Parrigot et ) . (Najenson et ,Nepomuceno et ) . (Walsh 2001) . MRI . 89 35% . (Shah et al. 2008) 53% .. 5. Shoulder Subluxation . Pathophysiology .. (Boyd 1992) .. rotator cuff .. (Chaco and Wolf 1971) ( ) . (Basmajian and Bazant1959 Shahani et )( ) . 6. Scapular Rotation Basmajian and Bazant(1595) .. Calliet(1980) . ( ) .. 7. Prevost et al.(1987) 3DX . 50 . ( ) .. (Prevost et ) Culham (1995) . ( vs ) . Price (2001) .. pain in Shoulder Subluxation (Crossens-Sills and Schenkman 1985, Moskowitz et al.)

4 1969b, Savage and Robertson 1982, Shai et al. 1984, Roy et al. 1994) (Kingery et al. 1993). 8. (Kingery et al. 1993) .. (Fitzgerald-Finch and Gibson 1975, Moskowitz et al. 1969b, Shahani et al. 1981, Bender and McKenna 2001) .. Paci (2005) .. ( vs ) ( ).. 9. 10. 11. Conclusions Regarding Shoulder Subluxation Post-Stroke .. HSP . HSP .. UMN .. 1 .. 12. Van Ouwenaller 1986 . 1 219 (18%). (85%) . 1 . Poulin de Courval (1990) . 94 . Bohannon (1986) 50 36 . Joynt(1992) . 67 .. Spastic Muscle Imbalance . 13.. 1 .. 90 . 2 .. Subscapularis Spasticity Disorder . (Holliushead and Jenkins 1981) . (Cole and Tobis 1990) . (Codman 1934) .. Bohannon (1986) . Zorowitz Hecht(1995) .. 14.. Inaba Piorkowski(1972) .. Pectoralis Spasticity Disorder Hecht(1995) .. 15. Frozen or Contracted Shoulder . Bohannon et , Eto et , Fugl-Meyer et , Grossens-Sills and Schenkman 1985, Hakuno et al. 1984, Risk et . 16. 17.. Conclusions Regarding Spastic Hemiplegic Shoulder .. Rotator Cuff Disorders.

5 Risk et al.(1984) . 30 . (Nepomuceno and Miller 1974) 33 . Najenson (1971) 32 13 (40%) .. Joynt(1992) 67 . 28 1 .. Functional Impact of Painful Hemiplegic Shoulder .. 18. 19. 4. 2 (Chae et al. 2007, Lee et al. 2009) .. Conclusions Regarding Functional Impact of Hemiplegic Shoulder pain outcome . Management of the Painful Hemiplegic Shoulder Risk et al. 1984 . Snels et al. 2002 .. 20. Positioning of the Hemiplegic Shoulder .. Gilmore 2004 . Davies . Bender McKenna 2001 Johnstone 1992 . Bobath 1990 Bender McKenna 2001 . Carr Kenny 1992 . Bender McKenna .. (Borisova & Bohannon 2009) 5 RCT 126 . 5 .. 2 2 . 1 6 .. 21. Conclusions Regarding Positioning of the Hemiplegic Shoulder Level3 .. Level4 .. Slings and Other Aids .. 22.. Ada 2005 .. RCT 4 Ancliffe et al. 1992, Griffin et al. 2003 [unpublished data], Hanger et al. 2000. and Hurd et al. 1974 .. 23. 1 .. Conclusions Regarding Slings in Hemiplegic Shoulder Level2 . Level2 .. 24. Strapping the Hemiplegic Shoulder .

6 3 .. 5cm Fixomull Stretch . Ancliffe 1992 1 . 4 1 . 2 1 2cm .. Morin&Bravo 1997 10cm Elastoplast adhesive bandage . 2 . 1 .. Hanger 2000 3 nonstretch Elastplast Sports tape . 2 5c .. 25. Conclusions Regarding Strapping the Hemiplegic Shoulder Level4 . Level1b .. Active Therapies in the Hemiplegic Shoulder .. 26. 27. Discussion Inaba 1972 PEDro=7 ROM. ROM ROM Kumar 1990 ROM . Lynch 2005 . OrthoLogic Danniflex600 Shoulder CPM system . Partridge 1990 . 3 ROM .. Conclusions Regarding Active Therapies in the Hemiplegic Shoulder . Level 1b .. Level 1b .. Level 1b . Level 1b . NSAID . Level 2 .. Level 1b .. NSAIDS . Electrical Stimulation in the Hemiplegic Shoulder .. (Price & Pandyan, 2000) . 2 FES . 2 TENS . FES .. 28. (Gresham et al. 1995) . Paci 2005 . FES . 6 5 6 FES 35. 50Hz Paci 2005 . Price & Pandyan 2001 ES . (a) (b) . FES .. Ada & Foongchomcheay 2002 . 6 RCT Baker & Parker 1986, Faghri et al. 1994, Kobayashi et al. 1999, Linn et al. 1999, Wang et al.

7 2000 .. 29. 14 FES . 30. 31. 32. 33. Discussion RCT ROM . EMG .. Faghri et al. 1994, Fil et al. 2010, Kiyuncu et al. 2010 . Baker & Parker 1986, Kobayashi et al. 1999 . FES Yu 2004 Chae 2005, 2007 . 1 TENS FES . FES .. Church et al. 2006 FES .. RCT Table 11. 17 . 34. Conclusions Regarding Electrical Stimulation in the Hemiplegic Shoulder Level 1a . Level 1a . FES Level 1a . FES . Surgery as Treatment for Muscle Imbalance .. 35. Conclusions Regarding Surgery as Treatment for Hemiplegic Shoulder pain . Level 2 . Botulinum Toxin Injections as Treatment for HSP.. Singh & Fitgerald 2010 . 6 RCT 6 . BT 3 6 . 1 . 36. 37. Discussion 4 RCT .. 2 TENS .. Conclusions Regarding Botulinum Toxin for Shoulder pain .. 38. Steroid Injections as Treatment for HSP.. 5 . 39. 40. Discussion 3 RCT HSP 2 . 3 TENS . 1 . Lim et al. 2008 .. Conclusions Regarding Steroid Injections for Shoulder pain . Level 4 .. Aromatherapy/Acupressure Treatment for Shoulder pain . 1 RCT.

8 41.. Conclusions Regarding Aromatherapy / Acupressure . Level 1b . Massage Therapy HSP . Mok Woo(2004) . RCT .. Conclusions Regarding Massage Therapy . 42. Subscapular Nerve Block for the Treatment for Shoulder pain .. 1 RCT.. 2 .. Conclusions Regarding Subscapular Nerve Block . Level 1b . 43. Summery of the Management of Hemiplegic Shoulder .. 8 RCT Koog et al. 2010 . 3 . (95% CI to ) . HSP .. NSAID RCT . Level 3 .. 90 . Gresham et al. 1995 . 44. 45. Compelx Regional pain Syndrome (CRPS) . Stages and Symptoms of CRPS. CRPS type type Type . Type CRPS . CRPS type .. Moseley et al. 2004 .. Iwata 2002 RSD 3 . CRPS . Davis et al. 1977 . MCP PIP .. CRPS . HSP . CRPS 4 1 . CRPS . 6 . 46. Pathophysiology of CRPS. CRPS CRPS ; .. Geurt (2000) . 5 6 11 .. CRPS . Iwata (2002) CRPS . ) .. Incidence of CRPS. CRPS . 47. 48. 49. CRPS RSD 12~32 . Petchkrua (2000) RSD .. 1 1 ROM .. TPBS CRPS type1 . 64 13 . RSD . RSD .. Kocabas et al. 2007 . Conclusions Regarding the Incidence of RSD Post Stroke RSD 12~48%.

9 Diagnostic Tests of CRPS. 1 SHS CRPS . 3 IASP 1994 Station-Hicks et 50. al. 1995 Bruehl Bruehl et al. 1999 . Veldman Veldman et al. 1993 . 70% 100% 36% 94% . ROM Quisels 2005 .. X Tepperman 1984 25 RSD. 2/3 .. RSD Kozin 1981 . RSD . 2002 4 . RSD . Conclusions Regarding Shoulder -Hand Syndrome CRPS .. Treatment of CRPS.. 1 2 . guanethedine . CI . (Acerra et al. 2007) .. RSD . SHS . Pertoldi & Benedetto 2005, Quisel et al. 2005 6 . Lieberman 1986 . Geurts 2000 SHS . 51. SHS 1 RCT.. Pharmacological Treatment of CRPS. 3 table . 52. Discussion CRPS-1 2 RCT 1 . 1 NSAID . Braus 1994 4 . Kalita 2005 . Conclusions Regarding Oral Corticosteroids in CRPS. 4 . Level 1b . 4 CRPS . Mirror Imagery as a Treatment for CRPS1.. CRPS-1 .. 53. 3 RCT . 54. 3 RCT Moseley 2006 1 Motor Imagery Program MIP 1 .. (Accera et al. 2007) .. 2 28 .. 20 .. Cacchio et al. 2009a . Conclusions Regarding Graded Motor Imagery 1a .. Passive Range of Motion Exercises for the Prevention of CRPS.

10 CRPS-1 . CRPS 1 . CRPS . Table . 55. CRPS .. CRPS . Conclusions Regarding Physical Therapy for Prevent CRPS. CRPS Level 2 . Calcitonin for the Prevention of CRPS.. CRPS-1 . 1 .. Conclusions Regarding Calcitonin to Prevent CRPS. CRPS Level 2 . 56. Summery 1.. 2.. 3.. 4. outcome . 5.. Level4 . 6. Level2 . 7. Level4 . Level1b . 8.. Level 1b . 9.. Level 1b . 10.. Level 2 . 11. NSAID . Level 2 . 12.. Level 1a .. 13.. Level 4 . 57. 14. Level 4 . Level 1a . 15.. Level 1b . 16.. Level 1b . 17. Level 1b . 18. CRPS . 19. 4 . Level 1b . 20.. Level 1b . 21. CRPS Level 2 . 22. Level 1a .. 23. CRPS Level 2 .. 58. 59. 60. 61. 62. 63. 64. 65. 66.


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