Winging Scapula

[Sharon Wagoner]

Hello everyone,

My husband's left scapula, shoulder blade, sticks up and the shoulder is pulled forward after a massive stroke. The OT people say there is not much we can do about it. I will not give up that easy. Have any of you had successful treatment for this problem? Is there a electrostimulation treatment? What would the + and - pad placement be? Need information on this. Are there any OT people on this forum?

[Sharon Wagoner]

I have been doing some research and I think what has happened is the Pectoralis minor (a triangular muscle in the upper chest connecting the breast area to the shoulder) has contracted and it is pulling the shoulder and shoulder blade forward. So putting a towel over the shoulder and leaning it against a door frame should help stretch the contracted muscle. Only push until the upper chest stretches but stop before it hurts. I am so mad at the therapists for giving up. Does anyone have any experience with this post stroke problem--winging?

[Sharon Wagoner]

Here is a pretty good article on muscle contraction and stiffness (tone or spasticity) due to stroke.

http://www.healthline.com/hgy-transcripts/spasticity-doc-info

[Dean Reinke]

This seems to be the most complained about deficit by survivors. However researchers seem to think spasticity is useful. Spasticity After Stroke: Why Bother? http://stroke.ahajournals.org/cgi/content/full/35/8/1787. ‘The focus on spasticity in stroke rehabilitation is out of step with its clinical importance’ I have yet to meet a survivor who thinks spasticity is useful and I know that if these researchers had spasticity they would not be saying that research is no longer needed. This was the most depressing finding on all my rehabilitation research. If you go to a doctor make sure you ask them if they are willing to treat spasticity.
Dean

[Sharon Wagoner]

Dean,

My husband was given baclofen for his spasticity. Not a good choice. It has the side effect of lowering the seizure threshold. He now takes gabapentin. I have found electro-stimulation, stretching exercises, and masage of tight muscles to be the most helpful for my husband.

I have spoken to people who are given botox injections. Don't know how well this works.

[Dean Reinke]

Sharon, The only thing I can suggest is to get some muscle anatomy books to figure out what controls what. The one recommended to me by my OT was Anatomy of Movement by Blandine Calais-Germain. It helps me visualize what muscles are being used for what movements and has some excellent diagrams
of walking.
I ended up buying a used copy from Amazon so i could match what muscles my therapists were talking about.
Dean

[Sharon Wagoner]

Good Idea!