Early Shoulder Management
by Jonathan Blood Smyth
Shoulder problems are a significant part of the workload of
a physiotherapist and an orthopaedic surgeon, with various
injuries and conditions affecting this joint. The shoulder
has the greatest range of motion of any body joint and this
requirement leads to risks of injury and the development of
pathologies. As the shoulder is a very unstable joint it is
vulnerable to dislocation in falls or vigorous activities at
the end of its range. Its structure and the repetitive
movements we perform predispose the shoulder to cuff tears
and its function as an emergency support when we fall makes
fractures a common occurrence.
The precise diagnosis of the condition and a clear agreed
treatment plan are essential in shoulder conditions as there
is a very large number of different fractures, operations
and injuries to the shoulder complex. Post-trauma and
post-operative shoulder conditions are part of the core work
of orthopaedic physiotherapists and they follow the agreed
trauma and elective surgery protocols, referring patients
for further treatment once they are discharged. Going over
the case quickly from the beginning once we meet the patient
is useful as this can throw up errors and missing facts
which need addressing. Patients also appreciate an
opportunity to tell their story.
The first consideration is supporting the shoulder to give
it some rest or to achieve a particular anatomical goal.
Broad arm slings are uncomfortable, difficult to fit (for me
anyhow) and awkward to adjust to the patient's requirements.
If one is used it will pull on the neck with the narrow part
of the sling and the knot, causing discomfort which can be
only partly alleviated by applying some foam padding. A
better solution is to use one of the more complex but much
more comfortable and adjustable slings such as the Seton
sling, a Velcro based sling which patients get on very well
with.
To get the best fitting and most comfortable fit for the
sling the physiotherapist needs to take a few actions for
success. The gutter for the arm should have the elbow placed
back as far as it will go and the hand can be kept out of
the sling by folding back the cuff part. The small Velcro
strap to close the forearm gutter should not be tightly
fixed as it may cut in to the upper arm, particularly if
there is a lot of oedema as swelling can occur after
fractures of the upper arm. Tightening up the main strap
which runs across the back and upwards over the shoulder is
a little more difficult to achieve a good result.
The Velcro straps are slightly elastic and also hold against
clothing or skin by friction, making them less likely to
slide when adjusted. Once the sling has been put on and the
strap tightened it is very likely that the elbow is not
being supported by the gutter. This can be checked by
feeling under the elbow to see if the sling is taking the
weight. Further tightening of the strap at the front just
results in more tension in the strap and not more support
for the elbow and thereby the shoulder.
Two people are needed to adjust the sling in co-operation, a
helper and the patient. The patient is asked to relax the
arm as much as they can while the helper lifts the weight of
the arm at the elbow, holding it there as they pull the
strap from its attachment at the back of the gutter up and
over the shoulder, then fixing it there with one hand.
Continuing to hold onto the strap which has been pulled
forwards the helper unstraps the Velcro fastening of the
main strap and tightens it up. Checking the support of the
elbow now will show it to be much better supported.
General advice to patients about sling management should be
given to cope with daily activities, the sling only being
off for dressing and washing. To wash the armpit the patient
should hold their arm in a position as if the sling was on
and then bend forward, allowing the arm to bend forward with
gravity. To put clothes on the affected arm should be placed
on first and with no significant movement of the arm
involved. - 15668
Jonathan Blood Smyth is Superintendent of a large team of
(http://www.thephysiotherapysite.co.uk) Physiotherapists at
an NHS hospital in Devon. He specialises in orthopaedic
conditions and looking after joint replacements as well as
managing chronic pain. Visit the website he edits if you are
looking for
(http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/lancashire/bolton)
physiotherapists in Bolton or elsewhere in the UK.
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New Unique Article!
Title: Early Shoulder Management
Author: Jonathan Blood Smyth
Email: david.ravech@overlandassociates.com
Keywords: Back pain,injury management,sciatica,Piriformis Syndrome,pain management,sciatica,back injury,back pain relief,Frozen Shoulder,Alternative medicine,physiotherapists,physiotherapy,Health,physical fitness,advice
Word Count: 709
Category: Health & Fitness:Alternative Medicine
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