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Uploaded: 2024-11-21T16:54:31.551Z
Duration: 1 min 50 s
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Henry Hoffman

Clinical Educator l Inventor | Blessed ✝️

Lower the Friction When it Comes to Shoulder Bursitis With Your Neuro Patients The subacromial bursa has long been described as friction-reducing tissue, which is often linked to stroke shoulder pain. The subacromial /subdeltoid bursa is the largest bursa in the human body, located at the shoulder laying between the acromion, deltoid, and the rotator cuff tendons. Shoulder bursitis is a common condition in the neuro population that can lead to significant discomfort and mobility issues. When it becomes inflamed, it can cause pain, swelling, and limited range of motion. Clinical Findings ⚠️ Pain develops gradually in the shoulder and lateral deltoid region and typically radiating down the upper arm. ⚠️The patient will experience pain during the painful arc test and usually one or more passive motions at end-range. Treatment The best treatment for subacromial bursitis typically involves a combination of therapy and corticosteroid injections. The removal of parts of the bursa (partial bursectomy) is also a common procedure in severe cases that do not respond to conservative treatments. 1. Therapy and Exercise: If your neuro patient is fortunate enough to have isolated voluntary movement (3/5 or greater), then performing humeral head depressors and scapular upward rotators exercises are recommended, along with stretching and manual therapy. 2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs, such as ibuprofen or naproxen, are routinely prescribed for pain and inflammation reduction. 3. Corticosteroid Injections: While steroid injections remain a mainstay for pain relief in persistent cases, they are generally used sparingly due to concerns over tendon weakening and joint cartilage deterioration with repeated administration. 4. Platelet-Rich Plasma (PRP) Therapy: This newer biologic treatment has gained attention as a minimally invasive option, particularly for individuals who do not respond to conventional therapies. PRP involves injecting a concentration of the patient’s own platelets into the affected area, which may promote tissue healing and reduce inflammation. 5. Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) has been explored as a non-invasive technique to stimulate blood flow, reduce inflammation, and alleviate pain. 6. Arthroscopic Bursectomy: For cases unresponsive to conservative measures, arthroscopic bursectomy—a minimally invasive surgical procedure to remove the inflamed bursa—may be indicated. To prevent or minimize the symptoms of bursitis in stroke patients with moderate to severe hemiparesis, in addition to proper positioning and careful stretching, consider de-weighting devices/mobile arm supports like the #SaeboMAS as part of the overall strength-training plan. #noplateauinsight

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Transcript

When stroke survivors complain of pain in the shoulder, do not overlook Bursitis. That is going to be one of the common conditions. It's going to be inflamed. It's going to hurt really bad. They're going to have limited motion. It's going to be some swelling. You're going to have that C5 dermatome pain where it's going to radiate. Distal patients will experience a painful arc when they go to raise arm, it's going to hurt. Or if you passively raise the arm, resistive test might hurt and internal rotation or external rotation resistive tests might hurt. Now, if they're high level and they have some really good movement, then that's when you're going to want to focus on the humoral head depressors. Those are the muscles, those cuff muscles that depress the humorous. When it elevate the arm, there's the acromion. Here's the humorous as you depress the humorous. Can then glide through and have that breathing room as you elevate the arms, you've got to focus on firing those internal external rotators. You also have to look at the scapulothoracic muscles. That's going to be your upward rotator. So your upper trap, lower trap and stratus anterior. Again, trying to give that head of humorous some breathing room as it elevates the arm. Now obviously if the stroke survivor is low level and the Brunnstrom stages does not show isolated movement, can't do anti-gravity movements, you're not gonna be ready for any of this. So that's when they're going to focus on electrical stimulation, some de weighting using let's say the sable mass. It's really just trying to hope for some strength so we eventually they can show some isolated movements. Of course you're going to work on some deltoid activity as well just to elevate the arm. That's. Gonna be important, just as important, it's going to be protecting the shoulder, proper stretching. So there's a lot you still have to do. But as they improve, we gotta watch out for that Bursitis and work on those humoral head depressors and scapular upward rotators.

Omar Ahmad

Founder and CEO at Neuro Animation Inc.

Abnormal synergies are partly caused by heightened activity in reticulospinal tract which is a result of non-damaged supplementary areas increasing functionality to compensate for lost areas of the brain. The miraculous thing is there is growing evidence that enough-training of the supplementary areas can disambiguate the signals and unwind the abnormal synergies, in addition to lead to true impairment reduction. Evidence clearly shows De-weighting the arm helps the brain -during- therapy to avoid the synergy. Ergo, doing neuro-centered therapy (not blind repetition, but brain-engaged active exploration and new motor movements) with something like the mas, especially early after injury, will lead to actual impairment reduction.

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