Looking After Your Shoulders

Transcription

1 A patient s guide to Looking After Your Shoulders Shoulder protection following a Spinal Cord Injury (SCI) This information, for patients with paraplegia, is a guide only and not prescriptive. Your therapist will consider your treatment on an individual basis. Patient Name Physiotherapist Occupational Therapist Date

2 Why is it important to protect your shoulders? Shoulder pain is a common complication following spinal cord injury with reported prevalence ranging from 30-70%. Shoulder pain can have a big impact on your sleep, functional ability and overall quality of life. As a result of needing to place increased weight and force through your shoulders to allow you to transfer and move, your shoulders are more vulnerable to wear and tear if not looked after well. This can limit you later in life. Research has found that shoulder strengthening and stretching exercises can reduce shoulder pain following a spinal cord injury. Improving your posture to aid shoulder alignment, considering the set up of your wheelchair (if appropriate) and reviewing your lifestyle can all help to reduce unnecessary strain to further protect your shoulders. Shoulder protection after SCI The purpose of this leaflet is to provide you with information to help you to look after your shoulders. Please ask for further information from your therapist if any of the following is unclear. At the end of the booklet is an exercise programme, please follow these exercises in addition to any that have been prescribed by your Physiotherapist or Occupational Therapist. 2

3 Anatomy The shoulder is one of the most mobile joints in the body allowing for movements in many different directions. With this wide range of movement comes reduced stability and vulnerability. The shoulder joint is made up of four bones connected by soft tissues. It is a shallow ball and socket joint and therefore heavily dependent on muscle activity for stability. Movement takes place at the main shoulder joint (glenohumeral joint) as well as the shoulder blade (scapula). The shoulder joint and the shoulder blade together is called the shoulder girdle. Tendon of supraspinatus Supraspinatus Humerus Subscapularis The group of muscles called the rotator cuff plays an important role in allowing the shoulder joint to move efficiently and in holding the joint together. Tendon of subscapularis 3

4 What causes shoulder pain? There are many possible causes of shoulder pain: Posture Poor posture can alter the biomechanics of the shoulder, for example, a slumped posture causes the shoulder blades to be pulled forwards and the shoulder to roll inwards. This leads to tightness of the muscles at the front of your shoulders and in the chest. As a result the muscles at the back of your shoulders can become lengthened and weaker. Also if you are wobbly and struggle to sit steady in your chair you may place increase strain through your shoulders and neck to help you sit still. Altered muscle length Overly tight or overly loose muscles may change the position of your shoulder girdle when you are at rest and when you are moving. Weakness Shoulder weakness can cause an imbalance of muscles, which can, in turn, lead to shoulder joint instability, pressing on the soft tissue around your shoulder (impingement), muscle tears and subsequent wear and tear (degenerative joint disease). Position when propelling wheelchair Poor positioning when propelling can put increased strain on your shoulders. 4

5 Ageing As you age the additional wear and tear associated with being in a wheelchair and/or using a walking aid may lead to shoulder pain. Repetitive use Repeated use of your upper limbs for weight bearing and lifting items, such as lifting your wheelchair in and out of the car or lifting things from over head, places an increased amount of stress on your shoulder joints and soft tissues. Impingement Soft tissue around your shoulder can get pressed against the bones in the joint as you move your arm. Pre-existing joint instability Pre-existing soft tissue issues could result in the shoulder joint being less stable. This could make upper limb activities harder by placing increased force through weaker shoulders and in turn this could lead to wear and tear. Trauma Direct trauma at the time of your injury or any other time can result in damage which may cause altered function in your shoulders and give you more pain. 5

6 Prevention - positioning and posture Postural alignment Check your posture for any asymmetries, e.g. one shoulder higher than the other, or one knee further forwards than the other. Also consider if you are sitting with a level pelvis (picture 1) or if your pelvis tilts backwards (picture 2). If you think there is a problem with your posture when sitting in your wheelchair speak to your Occupational Therapist for further advice. Propelling your manual wheelchair Your wheelchair should be set up to optimise your access to the wheels for efficient pushing. Picture 1 Picture 2 A recommended pushing technique is using a circular motion, allowing the hands to drop free at the end of the push and return to the rear of the wheel which allows a short rest for your arms (see picture 3). Picture 3 6

7 Reducing use and environmental set-up Complete pressure relief using a forward lean technique (rather than lifting) for the recommended consecutive two minutes every hour Try to minimise the number of transfers completed in a day and aim to make your most frequent surfaces at home are at the same height for these transfers Break up domestic activities e.g. clean the kitchen one day, clean the bathroom the next day Avoid twisting to access work surfaces and re-arrange cupboards to avoid over reaching Try to avoid weight gain and reduce your weight if heavier than your optimal Body Mass Index (BMI) as this will place more load on your joints. Contact your GP or LSCIC Consultant for a referral to a dietician if required If you are having pain or difficulty moving around in bed, it may be useful to consider an electrical profiling bed and the use of sliding sheets to help you move in bed with the assistance of a carer Consider use of power assist wheels to reduce the effort required to push your wheelchair Consider use of a powered wheelchair for outdoor mobility to reduce repetitive, effortful upper limb use Consider alternatives for lifting wheelchair in/out of a car e.g. wheelchair accessible vehicle or roof-top box Ask your Occupational Therapist for a review of your posture in your wheelchair 7

8 Prevention - strengthening Please complete the following exercises if the box has been ticked by your therapist. Strengthening of muscles around the shoulder girdle can improve the efficiency of movements. The following exercises target the rotator cuff muscles. Place your elbow and forearm on a table in front of you with your elbow bent at a right angle. Rotate your hand out to the side and back in to your body. Try to keep the movement as smooth as possible. Repeat 10 times on each arm. Lying on your back. Place your elbow out to the side with your elbow bent at a right angle so your hand points up to the ceiling. Rotate your arm down so your forearm rests on the bed and then raise your hand towards the head of the bed. Repeat 10 times on each arm. 8

9 Theraband exercises Sit with your elbow bent at a right angle. Keep the elbow against your body and your hand placed on the tummy. Pull your hand and the theraband out towards the side as far as possible. Keep your elbow tucked in and your wrist straight during the movement. Slowly return to starting position. Repeat 10 times on each arm. Sit with your elbow bent at a right angle. Keep the elbow against your body and place your hand out towards the side. Pull your hand and the theraband towards your tummy. Keep your wrist straight during the movement. Slowly return to starting position. Repeat 10 times on each arm. Sit with your elbows slightly bent in front of you. Pulling the theraband towards you in a rowing like motion backwards while bringing the shoulder blades together. Repeat 10 times. 9

10 Prevention - stretching The muscles at the front of your shoulders can become short and tight when propelling your wheelchair or using a walking aid. The following stretches will help to avoid this. Lying flat on your back, take your arms out to the side and place your hands behind your head, resting your elbows on the pillow. Hold your arms here for 30 seconds. You can do this exercise one arm at a time if you want to. Repeat 3 times. Stand or position your wheelchair in a door frame. Place your hand in the doorway with your arm out to the side and at 90 degrees. Turn your upper body or the chair away from the doorway so you stretch the front of your chest. Hold this for 30 seconds. Then repeat on the other arm. 10

11 Notes 11

12 If you would like this leaflet translated into another language/large print, please contact the Quality Team on Royal National Orthopaedic Hospital NHS Trust Brockley Hill Stanmore Middlesex HA7 4LP Switchboard: / RNOH Date of publication: April 2018 Date of next review: April 2020 Author: Amelia Rickenbach