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Orthopedic Considerations for the Post-Stroke Upper Extremity

Presented by Lisa Juckett

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Complications after stroke are vast and distressing, impacting the quality of life and independence of millions of stroke patients. Upper extremity impairment constitutes one of these highly devastating complications. As neurorehabilitation practitioners, we have the responsibility to treat and manage upper extremity deficits that have resulted from neurological insult. However, impairments in the neurological upper extremity are often influenced by orthopedic factors that can hinder patient progress and function. A strong foundation in neuromusculoskeletal anatomy and kinesiology can help enhance therapy approaches to managing the post-stroke upper extremity and facilitating desired outcomes. This course is designed for practitioners who seek to gain knowledge of orthopedic considerations related to the neurological upper extremity with emphasis on the shoulder complex. Content from this course will address the neuromusculoskeletal mechanisms that influence upper extremity movement, upper extremity conditions that may result after stroke, and strategies for managing the painful shoulder girdle.

Meet your instructor

Lisa Juckett

Lisa Juckett has served as a clinical instructor at The Ohio State University in the Occupational Therapy Division since 2011. She has extensive clinical experience in the inpatient rehabilitation and skilled nursing settings. Her position as an inpatient clinician led her to collaborate with researchers at The Ohio State…

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Chapters & learning objectives

Upper Extremity Anatomy

1. Upper Extremity Anatomy

This chapter will review the neurological mechanisms behind upper extremity impairment after stroke. Additionally, this chapter will review key neuromusculoskeletal structures of the UE to provide clinicians with a strong anatomy foundation.

Shoulder Pain Post-Stroke

2. Shoulder Pain Post-Stroke

This chapter will address select orthopedic considerations for addressing shoulder pain after stroke. Content will focus on capsular contractures, supraspinatus impingement, and complex regional pain syndrome (CRPS) to provide practitioners with evidence-based treatment strategies.

Shoulder Subluxation

3. Shoulder Subluxation

This chapter will review the mechanisms that influence shoulder subluxation in the neurological upper extremity. Shoulder subluxation pathology will be reviewed, and intervention suggestions will highlight evidence-based strategies to improve glenohumeral integrity.

Posture Imbalances

4. Posture Imbalances

This chapter will highlight the importance of postural stability as it relates to the neurological upper extremity. Key components of this chapter include discussions of musculoskeletal imbalance, the connection between posture and the upper extremity, and strategies to improve posture in the stroke population.

Orthoses and other treatments

5. Orthoses and other treatments

This chapter will present evidence for orthosis use among the stroke population. Additionally, this chapter will introduce adjunct treatments to be used in a multidisciplinary setting, such as the inpatient rehabilitation setting. This presentation will conclude by emphasizing the importance of patient and family education for upper extremity management.