脑卒中后肩部问题

Shoulder problem associated with brain stroke

脑卒中后常见的肩部问题包括:肩关节半脱位、肩手综合征和肩痛。(1)肩关节半脱位治疗包括:矫正肩胛骨的位置,恢复肩原有的锁定机制;刺激肩关节周围固定肌的活动及张力;在不损伤关节及其周围结构的前提下,保持肩关节无痛性的全范围被动活动。(2)肩-手综合征治疗主要是减轻水肿和疼痛,改善手、腕关节的活动度。(3)肩痛的治疗包括改善肩胛骨活动度、体位摆放、增加被动活动度及指导患者采用正确的肩关节运动来逐步改善患者的症状。

The common problems of shoulder associated with brain stroke include the subluxed shoulder, the shoulder hand syndrome and the painful shoulder. (1) The subluxed shoulder is mainly caused by the loss of muscle tone and the relaxation of the joint capsular. The treatment of the subluxed shoulder is to correct the position of the scapula, to restore the natural locking mechanism of the shoulder, to stimulate activity and tone in the stabilizing muscles around the shoulder, and to maintain full pain free range of passive movement without traumatizing the joint and the structures which surround it. (2) The shoulder hand syndrome is related with mechanical trauma, inadequate muscle pump of upper limb, and sympathetic nervous system involvement. The symptoms of shoulder hand syndrome are swollen hand and upper limb, limitation of range of movement. In final or residual stage, the hand becomes deformity and the mobility is lost. The treatment is to reduce the edema and pain, to improve range of movement of hand and wrist joint. (3) The painful shoulder hinders the physical therapy and occupational therapy and decreases the ability of living. Particular attention should be given to the patient's position when lying in bed or sitting in the chair, and to how he is assisted when he moves. The treatment is to improve the range of scapula, position in bed, increase the range of passive movement and instruct the patient how to move his shoulder correctly and reduce shoulder pain gradually.