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    Varney Brace

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    taniamahapatra1
    This document discusses precautions for using a Varney brace to treat hemiplegic shoulder pain following a stroke. It should only be used for 7 days until muscle tone is sufficient to prevent subluxation. Exercises should always accompany brace use to prevent contractures. Several treatments for hemiplegic shoulder pain are discussed, including TENS, FES, and botulinum toxin injections, all of which showed benefits like reduced pain and improved range of motion. Proper handling and positioning of the affected arm is important to prevent shoulder pain during stroke recovery.

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    Varney Brace

    Uploaded by

    taniamahapatra1
    935 views2 pages
    This document discusses precautions for using a Varney brace to treat hemiplegic shoulder pain following a stroke. It should only be used for 7 days until muscle tone is sufficient to prevent subluxation. Exercises should always accompany brace use to prevent contractures. Several treatments for hemiplegic shoulder pain are discussed, including TENS, FES, and botulinum toxin injections, all of which showed benefits like reduced pain and improved range of motion. Proper handling and positioning of the affected arm is important to prevent shoulder pain during stroke recovery.

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    Varney brace

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    This document discusses precautions for using a Varney brace to treat hemiplegic shoulder pain following a stroke. It should only be used for 7 days until muscle tone is sufficient to prevent subluxation. Exercises should always accompany brace use to prevent contractures. Several treatments for hemiplegic shoulder pain are discussed, including TENS, FES, and botulinum toxin injections, all of which showed benefits like reduced pain and improved range of motion. Proper handling and positioning of the affected arm is important to prevent shoulder pain during stroke recovery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    935 views2 pages

    Varney Brace

    Uploaded by

    taniamahapatra1
    This document discusses precautions for using a Varney brace to treat hemiplegic shoulder pain following a stroke. It should only be used for 7 days until muscle tone is sufficient to prevent subluxation. Exercises should always accompany brace use to prevent contractures. Several treatments for hemiplegic shoulder pain are discussed, including TENS, FES, and botulinum toxin injections, all of which showed benefits like reduced pain and improved range of motion. Proper handling and positioning of the affected arm is important to prevent shoulder pain during stroke recovery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    PRECAUTIONS

     Varney brace has been reported to be successful: patients become asymptomatic within seven
    days.
     External support can be discontinued whenmuscle tone around the glenohumeral joint is
    sufficient to prevent subluxation.
     An exercise programme should always accompany the use of a sling.
    However, a number of authors have reported that slings may hold the limb in a poor position
    that is likely to cause soft tissue contracture and have an adverse eVect on symmetry, balance,
    hese include
    physiotherapy, localised cooling, infrared, ultrasound can also help in controlling painwhile sling
    is on.

     Wanklyn et al studied the prevalence of hemiplegic shoulder pain and associated factors in
    patients with stroke Sixty three percent of the patients developed hemiplegic shoulder pain
    in the first six months after their stroke. Patients who needed help with transfers were more
    likely to develop hemiplegic shoulder pain. Certainly, patients with markedly decreased
    voluntary movement after a cerebrovascular accident frequently experience shoulder joint
    mal alignment or subluxation in the early stages of recovery.
     Braus et al investigated the efficacy of an information and education programme in the
    prevention of hemiplegic shoulder pain. All members of the diagnostic and therapeutic team
    as well as patients and their family were provided with instructions on how to avoid injuries
    to the affected limb. The investigators found that awareness of potential injuries to the
    structures of the shoulder joint reduced the frequency of shoulder pain from 27% to8%.
     Fitzgerald-Finch et al advocated the use of the Australian lift when handling these patients:
    they felt it to be of value as the weight of the patient is taken on the shoulders of the carer
    and the patient’s shoulder is protected.
     Leandri et al evaluated the effectiveness of high intensity versus low intensity
    transcutaneous electrical nerve stimulation (TENS) versus placebo for patients with
    hemiplegic shoulder pain.Low intensity TENS involves electrical stimulation just above the
    level of the skin sensory threshold. High intensity TENS is suYcient to elicit muscle
    contraction and an almost painful sensation. The investigators found that patients who
    received high intensity TENS had significant improvements in passive range of motion for
    flexion, extension, abduction, and external rotation at the shoulder. The patients who
    received high intensity TENS also reported very satisfactory pain relief.
     Faghri et al studied the eVects of a FESy demonstrated a beneficial effect on subluxation and
    improvement in other parameters such as pain, range of motion, and arm function.
    BOTULINUM TOXIN

    Bhakta et al evaluated the impact of botulinum toxin on disability caused by upper limb spasticity after
    stroke.They demonstrated improvement in shoulder pain in six of nine patients treated with complete
    resolution in two patients

    Points to remember

    1. Hemiplegic shoulder pain aVects stroke outcome in a negative way. It interferes with

    recovery after a stroke: it can cause considerable distress and reduced activity and can

    markedly hinder rehabilitation. Hemiplegic shoulder pain has been associated with

    prolonged hospital stay and poor recovery of arm function in the first 12 weeks after

    stroke.

    2. The cause of hemiplegic shoulder pain is the subject of considerable controversy. The

    following processes have all been postulated as causes of a painful hemiplegic shoulder:

    glenohumeral subluxation, spasticity of shoulder muscles, impingement, soft tissue

    trauma, rotator cuV tears, glenohumeral capsulitis, bicipital tendinitis, and shoulder hand

    syndrome. The aetiology of hemiplegic shoulder pain is probably multifactorial.

    3. The mobility of the recovering stroke patient is dependent on the assistance of nurses,

    therapists, doctors, other ancillary staV, and family members. It is also dependent on the

    patient’s own eVorts. Poor handling and positioning of the aVected upper limb in stroke

    patients contribute toward shoulder pain.

    4. Important outcomes include pain relief, improved passive and active range of motion and

    arm function.

    5. Indications for surgery in patients with hemiplegic shoulder pain include limitation of

    range of motion to the point of functional impairment, pain of such intensity that it

    interferes with skin hygiene or prevents participation in rehabilitation.

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