Low level laser for shoulder pain -after stroke - and shoulder injury

Causalgia, reflex sympathetic dystrophy, and the shoulder - hand - finger syndrome have been group into a characteristic medical condition that may cause severe, intractable pain and progressive functional impairment and disability

This condition is not rare for stroke problem

The circulation of upper extremity can be roughly divided into arterial and venous component : first, the arterial component. It is refers to cardiac pumping, proceeding to the distal portion of the extremity. The 2^nd are the venous return and lymphatic system. The muscles of the hand and arm force the fluid proximally by means of “pumps”

Mr Djoko, got stroke , nearly two years ago, hemiparetic with spasm at his right hand. This was the iniciating factor for his problem. He sent by neurologist due to pain on his right side. I found shoulder limitation , and swollen.

Low level laser given by transcutaneus approach 5 times ,everyday. I asked him to move his right extremity frequently.

Injury of shoulder

Mr Djoko visited my office again two weeks ago. This time, the pain suffered his left hand. almost a month ago, he slipped on stairs, grabbed the guard raill by his left hand. His tendon of biceps became overstrech.

Three times simultaneus transcutaneus low level laser not enough for this condition. It was very painfull for him, sometimes he feels pain on his chest

I used ILIB , combined with probe to delivery the laser. Probe go a long tendon biceps , also administered to ganglion stelata to block the nerve. Pain decreased , and diminished after the 7th treatment.













Discussion:

Pity mr Djoko. Yes, we could deliver laser as a nerve block, like using anesthetic agent.

An effective stellate block is judged if there is pain relief. Mr Djoko found, after stellate block using laser, the pain relief more rapid.

For both shoulder, the stiffness should be treated . active exercises of the shoulder and hand must be instituted as soon ans as energitically as the medical condition permits.

Mr Djoko found, along with pain decreasing , his hemiparetic side could moved more easily.

For his right arm, the problem iniciated only of his shoulder limitation , but for the left side, the manuver slipped on strairs sreching the biceps and the brachial plexus. So, it is more painfull, and more difficult to manage.
May be probe as anaesthetic was enough, but his fear must considerable. A man, both side hand injures , still works as goverment employee, it is fearfull.

There are some papers about laser for causalgia. I didn't find yet laser administered to the ganglion. I saw this kind aproach when I joined WALT Conggres in Tsukuba Japan, 2002.

prevent your back - exercise

Prevent your back

Tips for you, to prevent from Low Back Pain (LBP).

But, if you already suffer from LBP, please ask your doctor first, which suitable for you

Exercise please

De Quervein’s Diseases.

Mrs Hizkiah, a beautiful nurse, funny, always smile.

She fells pain, aggravated by movement on the wrist and thumb. Dear Hiskiah, it is call De Quervein’s Diseases. Characteristic symptoms can be reproduced by flexing the thumb and cupping it under the fingers, than flexing the wrist in an ulnar direction which streches the thumb tendons. Lovely Hizkiah, that is the reasoning, why your pain exaggerated after your therapist asked you to made a fist, forcing flex the thumb.

Pity Hizkiah, you also has another problem ., trigger thumb. In this condition your thumb snaps as it flexes and may become locked in flexion or in extension. He didn’t want to harm you, just didn’t knoe that you have another problem.

The patology De Quervein’s Diseases is an increased vascularity of the outer sheath that, coupled with edema, thickens the sheath and constricts the enclosed tendon. Treatment requires immobilization with injections of cortisone into the sheath.

My regiment for you is low level laser. Please, no heat modality, due to edema. Low level laser will not increase the temperature above body temperature. It is to reduce the pain and the edema. I am going to immobilize your thumb. But if during four weeks of treatment, there is no relief , may be our surgeon will help you.

The trigger thumb, occurs from thickening of the sheath or the tendon or both which prevents gliding of the tendon within the sheath . Local injections of cortisone into the sheath may result in good recovery . if locking persists , excision of the thickened is performed. That is not my competent. I told you, my first concern is your pain due to De Quervein’s. I use low level laser AMM50, about 830 nm, probe 50 mW, The dose 30 Youles. It is big enough. I am going to decreases the dose if your pain and edema decrease.

(Hand pain and impairment, Rene Cailliet)

De Quervein's

Trigger Thumb