Subluxation

[Jerrolyn]

Hello. My mother has a one finger shoulder subluxation. She was doing very well in therapy before this happened. Since the subluxation she has only really received electrical stimulation and some massaging. We are using kinesio tape to keep the shoulder in place. She is receiving in home care right now and I feel that enough isn't being done with her arm/hand to help her get any function back. My sisters and I work on her hand everyday and we just ordered the empi 300 PV for her so she will receive the electrical stimulation while at home. I am feeling very frustrated. Have any of you had a subluxation that actually got better? I am also looking into the Saebo flex for her. Is there anything else someone can suggest to help with the subluxation?

[Ethyl17]

Jerrolyn: welcome. My Bruce's shoulder subluxed three fingers with the stroke. He wore a shoulder harness, a sling, was taped. Now, the muscles around the shoulder socket must re-strengthen to get the shoulder back in its saddle. Unlike the hip, which is a ball and socket; the shoulder is more like a ball (top of the arm) fitting into a cup. There is nothing on the cup that helps secure the upper arm bone, so all the work has to be done by the muscles. You can expect about 3cm reduction in the subluxe every 4 to six weeks (about 1/2 the finger width).

 

Now the problem with this is any aggressive therapy on the arm can cause further muscle damage, so most OTs won't even touch the arm other than some gentle Estim. During Bruce's recovery from his subluxe, he worked the lower arm gently: lay on table, push out, pull in, move forward, back etc. This was the lower arm only. And he had to be taped or in his harness because he would try to use his shoulder-back to move the lower arm-almost like a rocking movement (very bad). So we had to limit even that.

 

Regardless of the subluxe, the hand will probably come back last anyway. So yes, daily work on the hand and a night splint to keep it from contracting. Estim on the hand is really on the lower arm. So before you start any Estim, have OT give you placement and settings for the shoulder and the hand.

Frustrating I know, but go easy that shoulder is very fragile right now. It'll come. Please keep us posted. Debbie, caregiver to Bruce, stroke 2009

[fking]

You have to remember the brain cells on that side of the body is no long working so you'll get just so much back from the muscles in the shoulder. The brain is what controls all your body parts, the PT and OT exercises the muscles but the nerves has lost control as well. My left side is affected and I can only do so much with it in therapy.I can work my index finger like before the stroke but the other fingers on my left hand doesn't work that much.

Fred!

[Jerrolyn]

Debbie,

Hi. I was told that the only way a subluxation could be corrected would be if the muscles holding the shoulder joint start to work which would mean that the brain would need to send signals to that muscle. The kinesio tape and the electrical stimulation are helping but until that muscle starts working the sublux will be there. I'm not sure what you mean when you say we can expect a decrease in the sublux every 4-6 weeks. Is Bruce's shoulder now back in place? Can he range it at all?

Thanks

[heidiw921]

i should have bought stock in the kinesio tape company-i would be a millionaire today! that, the stroke sling and weight bearing fixed the problem along with alot of determination. go for the saeboflex to regain hand function just don't expect miracles overnight. i'm on my 2nd year working with it twice a day and still don't have full function...getting there but not like before my stroke--yet.

[Jerrolyn]

Heidi,

What types of weight bearing exercises did you do? I am looking into the saeboflex for my mom but have to wait until she finishes in home care first.

Thanks

[Ethyl17]

Jerrolyn: Bruce's shoulder is back in it socket. Took eight months and yes he has total range with the shoulder, but can not do it himself. Still no movement in the arm or the hand. He exercises both the arm and the hand when sitting reading or watching TV by doing it with his unaffected arm and hand. Holds his wrist and does lifts with the arm and in and out with the hand and fingers.

 

OT can get the arm above his shoulder and about 30 degrees behind him. He Estims the shoulder twice for one half hour, every day. The shoulder itself has good movement: shrugs, push forward, push back, circles.

 

I am sure there are shoulders that have never returned to their sockets, but since the shoulder is so close to the main trunk of the body, I never gave up that Bruce's would return. Biggest thing was proper position, Bruce tends to hunch forward, but with a lumbar cushion in the rented WC and now with the custom WC, his posture sitting is excellent, except when he gets tired and then it is to bed for some down time. Since lying on his back in bed puts the shoulder in perfect position, we did a lot of exercises when he was in bed, under OT's teachings, because I could be more aggressive.

 

I hope this helps. Debbie

[Jerrolyn]

Thanks Debbie for the info. We are hoping to start estim this week with our empi. I'm hoping the sublux corrects itself soon as I feel we are losing so much time with the arm.

[heidiw921]

the weightbearing exercises were pretty simple-just put my fist on the table and put my body weight into it.quite painful in the beginning but the pain has somewhat subsided. now i'm doing weight bearing on my exercise ball-put myy fist on the floor with the ball under me and just roll my weight onto the arm. i am not in PT or OTanymore so this is an execise i came up with on my own. good luck

[leese]

I've got my sublux down to about 1/2 a finger;which is a full finger less than this time last year, and two fingers less than two years ago. I try to bear weight through the extended arm when I'm sitting with my palm on the chair. I also use some weight machines at the rehab gym that engage the shoulder muscles with a pushing motion on my OTs advice.It's been a slow road with it, but it's getting better.

[Cduff33]

Does anyone have a used unit they are no longer using they would be willing to sell????? I am looking for the EMPI 300PV

 

Jerrolyn, are you now using the saebo flex? My wife was using in during inpatient rehab and saw great results..unfortunately the outpatient rehab center does not have this equipment, but I am trying to find a way to get it for her again.

[phildogg]

Try to put a pillow under the arm. Specifically, the elbow region. I sleep with one every night. It doesn't have to be a big pillow, a small one will do, kinda like a half pillow size. The sublaxation eventually goes away. But it was a long time getting my shoulder to stop hurting. Nothing happens overnight when it comes to strokes.

Hope this helps.

 

Cduff33, I was thinking of starting an exchange for gently used medical devices. But, due to lack of interest, I abandon the idea. But, I'm still holding out hope that one day I could make it happen.

[Jerrolyn]

Does anyone have a used unit they are no longer using they would be willing to sell????? I am looking for the EMPI 300PV

 

Jerrolyn, are you now using the saebo flex? My wife was using in during inpatient rehab and saw great results..unfortunately the outpatient rehab center does not have this equipment, but I am trying to find a way to get it for her again.

Hi. My mom volunteered at a saebo training seminar for the saebo flex and is eligible for 30 free days with the unit. We liked what the saebo flex did for her. The catch is this: My mom is currently doing outpatient ot and pt. Only a saebo trained technician can fit the unit to my mom and then work with her on using it. It has been very difficult to find someone who is saebo trained in our area. Also, my mom can't do therapy at two different places as her insurance won't cover it. So, we are going to do some ot with the person she is currently with and then get a prescription for an orthotic fitting and do some therapy with a saebo technician. The flex costs about $2,000 I think if it is not covered by your insurance. If you go on to the saebo.com website and type in your area code you will get a list of saebo therapists in your area. Then, you need to see if your insurance is taken at this facility. Good Luck.

[gmeager]

Does anyone have a used unit they are no longer using they would be willing to sell????? I am looking for the EMPI 300PV

 

Jerrolyn, are you now using the saebo flex? My wife was using in during inpatient rehab and saw great results..unfortunately the outpatient rehab center does not have this equipment, but I am trying to find a way to get it for her again.

Hi. My mom volunteered at a saebo training seminar for the saebo flex and is eligible for 30 free days with the unit. We liked what the saebo flex did for her. The catch is this: My mom is currently doing outpatient ot and pt. Only a saebo trained technician can fit the unit to my mom and then work with her on using it. It has been very difficult to find someone who is saebo trained in our area. Also, my mom can't do therapy at two different places as her insurance won't cover it. So, we are going to do some ot with the person she is currently with and then get a prescription for an orthotic fitting and do some therapy with a saebo technician. The flex costs about $2,000 I think if it is not covered by your insurance. If you go on to the saebo.com website and type in your area code you will get a list of saebo therapists in your area. Then, you need to see if your insurance is taken at this facility. Good Luck.

[gmeager]

Hi I don'T know if I will be of any help to you but I had a similar subluxation in my Left shoulder when I stroked in July 04. I never recieved any specific treatment to the shoulder other than 3 times weekly physio, .upon my discharge from hospital the physio continued in the form of daily exercises using various strengths rubbr bands tied to a door I eventually got most of the movement back but there are still weaknesses on my left side despite going regularly to the gym 3 times a week. I find it hard to lift more than 2lb above my head and still get some pain within the shoulder joint.

I hope your mum recovers well and maybe joins us in the chat room sometime

HOSTGED

[Ethyl17]

I guess Bruce just got lucky. After reading through all the posts, I never thought his arm muscles would not move back into the shoulder girdle. I now check that shoulder connection daily, guess I can't believe our good luck. Bruce has no use of the arm or hand. When he moves the shoulder, it is truly from his back muscles, not the shoulder. He was in a sling for a long time, then the special shoulder harness. He was taped for one week.

 

I am so sorry if I misled anyone. Bruce's main issue was the use of the sling and the tightening of his Pec, that the Botox fixed. From the advice I received early on, sublux was normal and would correct itself over time. Apparently, that is not so. But he does Estim shoulder twice, for one half hour, every day and since there is still no true shoulder movement, I am seriously thinking of increasing his wattage. Debbie

[coneill]

My husband had a left-side stroke six months ago and his left shoulder is subluxated (word?). He's currently in a rehab facility and I anticipate he's nearing ability to be discharged.

 

His left wrist is crimped at almost a right angle. He does have some movement in arm and hand, and mobility in his fingers, so he has something to work with. This past week for the first time, he was able to tear open sugar packets for his coffee by himself (!). He is motivated to get as much function back as possible.

 

I try to help him with range of motion exercises and shoulder massage but feel there is far more we could be doing that would benefit him. The PTs have done e-stim on him and have provided him with a sling. Has anyone had any experience with ultrasound? The PTs have discussed using it on the crimped wrist, but so far, haven't done it.

 

coneill

[Ethyl17]

coneil: get him out of the sling! There are shoulder harnesses and special taping for the sublux. I posted about Bruce's shoulder. Bruce's recovery was exactly what his original OT told us. I did not realize that that did not happen with everyone, so hesitate to mention it again. He is better off resting the arm on a pillow in his lap, with the shoulder in position. A sling will cause problems with the chest muscles-specifically the Pec. While waiting for Bruce's sublux to heal, he was in a sling and once the shoulder got back into position, took three rounds of Botox to release his Pec.

 

Bruce Estims his shoulder twice daily. The pads are short-lived and expensive. But there are sites, on-line (maybe Ebay), where you can get them cheaper. If you go this route, post your model and I am sure someone will be able to advise you. Bruce's OT did a few sessions with ultrasound on his hand, but I think the idea was that if he did not have function in his shoulder-arm, hand wasn't coming back first. Since Dave has movement, insist they give it a try.

 

If the shoulder is not in position, you can not be too aggressive with exercise there. Can cause more damage. Do what you are doing, what OT has suggested and just feel that shoulder joint. You won't see major change, but I used my own fingers as a measuring device and as I lost a finger: lol-as the sublux reduced, would check in with his OT as to what to add.

 

Since Bruce gets Botox every three months, I can ask for therapy re-eval. Last time he did not qualify for any OT but we were able to have him evaluated and OT advised what to do. He upped the E stim amount and this next round we shall see where we are at. Disclaimer- lol: I was told Bruce was subluxed initially about 3 cm. I could expect 1/2 cm improvement about every 2 months or so-two fingers. So it took 9 months for Bruce's shoulder to get back in position and the aggressive therapy to begin. That was just about a year ago. Just this past month I am noticing some arm movement. It is spontaneous, almost reflex. Bruce does not know he does it until it happens-so he is not "trying" to do it.

 

One other suggestion, he needs an overnight or resting splint. Some therapists want it on all the time, Bruce's is just overnight. But keep in mind that Bruce has no movement in his arm-hand. This keeps the hand in position, won't allow contraction. When the hand is "tight" getting it on is painful and difficult, but if you need help, let us know. There are some tricks that help.

 

An exciting and scary time for both of you. So many issues. Keep good notes, so you have good follow up. And then just look forward to the time you will have with him at home, dealing with all of this from a "safe" and controlled spot. Debbie

[coneill]

Yaaay, thanks, Ethyl17, for such a well-informed evaluation of treating what I know will be a stubborn problem.

 

I introduced Dave to the stroke board yesterday and read my above post to him. I will share your response with him as well. We are currently working on computer accessibility issues (e.g. Dragon speech recognition software) so that Dave will be able to go online on his own again. I hope this post helps others.

 

coneill

[Jerrolyn]

Coneill,

Hi. My mom currently has about a 1 1/2 finger subluxation of her shoulder. We have been doing weight bearing exercises and range her in bed to keep the shoulder in proper position. I have not seen any change so far in the sublux. She sleeps at night with a splint to keep her fingers from curling and uses a sling only when she goes out. We got her the GivMohr sling which is supposed to specifically be for subluxation. Her OT had her get a fanny pouch for transfers and she just tucks her hand into that when she gets up to go to the bathroom, for instance. When she is sitting she tries to keep her arm out in front of her. We have been told by a few OT's that the sublux is a brain thing. The brain is not sending signals to the shoulder muscle so it is unable to hold the joint in place. Unless the brain sends the signal the sublux will not go away. I know a few people on this site have mentioned that they have been able to decrease their sublux's. Perhaps there was enough healing in the part of the brain that controls the shoulder muscle to allow this to happen. I hope it happens for you!

[loeideverre]

Yaaay, thanks, Ethyl17, for such a well-informed evaluation of treating what I know will be a stubborn problem.

 

I introduced Dave to the stroke board yesterday and read my above post to him. I will share your response with him as well. We are currently working on computer accessibility issues (e.g. Dragon speech recognition software) so that Dave will be able to go online on his own again. I hope this post helps others.

 

coneill

Coneill,

Hi. My mom currently has about a 1 1/2 finger subluxation of her shoulder. We have been doing weight bearing exercises and range her in bed to keep the shoulder in proper position. I have not seen any change so far in the sublux. She sleeps at night with a splint to keep her fingers from curling and uses a sling only when she goes out. We got her the GivMohr sling which is supposed to specifically be for subluxation. Her OT had her get a fanny pouch for transfers and she just tucks her hand into that when she gets up to go to the bathroom, for instance. When she is sitting she tries to keep her arm out in front of her. We have been told by a few OT's that the sublux is a brain thing. The brain is not sending signals to the shoulder muscle so it is unable to hold the joint in place. Unless the brain sends the signal the sublux will not go away. I know a few people on this site have mentioned that they have been able to decrease their sublux's. Perhaps there was enough healing in the part of the brain that controls the shoulder muscle to allow this to happen. I hope it happens for you!

 

I bought the GivMohr sling for my mom after reading your post. I like the way it positions my mom's arm however she refuses to put the hand part in (it is akward) How if the GivMohr sling working for you?

[Jerrolyn]

Hi everyone. Well I have another question. My mom's OT is telling her that her subluxation has pretty much gone away. When I look at my mom though her right affected arm/shoulder still seem to be hanging lower than the left side. Her arm/shoulder has looked this way all along so how can the sublux be healed? Could the arm/shoulder be hanging like this due to muscles that aren't strong enough to hold it up? All summer my mom's t-shirts kept slipping off of her affected shoulder and she looks lopsided. I still feel she looks the same way. Any input?