Young people who are targeted by cardiovascular and cerebrovascular diseases must not miss the opportunity for early recovery
Cardiovascular and cerebrovascular diseases are considered to be senile diseases in many people, but in fact, people of any age can suffer from this disease.
In recent years, my country’s cardiovascular and cerebrovascular diseases have become more youthful. In 2019, the “White Paper on Cardiovascular and Cerebrovascular Health of the Young and Middle-aged in China”, led by the National Cardiovascular and Cerebrovascular Diseases Association of the National Center for Geriatric Diseases Research, shows that 20-29 years old The proportion of the sick/high-risk population has reached 15.3%, and the treatment status of the sick/high-risk young and middle-aged people is not ideal, and 64.4% have not received medical treatment.
To prevent cardiovascular and cerebrovascular diseases such as stroke, we must exercise scientifically, live a regular life, quit smoking, not be too emotional, and go to the hospital for regular check-ups to prevent it.
If unfortunately, "spotted" by a stroke, how can we recover?
A few days ago, at the 2020 Fourth Comprehensive Academic Annual Conference of the Chinese Association of Rehabilitation Medicine, Chen Hongxia, director of the Department of Rehabilitation Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, cited stroke hemiplegia as the most common and difficult complication-shoulder pain after stroke, also known as " Taking hemiplegic shoulders as an example, we introduced the importance of early interventional rehabilitation of stroke.
The incidence of "hemiplegic shoulder" in stroke patients with hemiplegia is 48%-84%.
Generally speaking, patients do not have pain in the early stage, and the pain will be obvious two to three months after the onset of stroke.
Therefore, Chen Hongxia said that prevention is very important, and early intervention will prevent the disease from developing in a serious direction.
“Shoulder pain after stroke increases the patient’s pain. Long-term chronic pain can easily cause emotional depression and anxiety; hinder rehabilitation, affect the rehabilitation of upper limb motor function, and prolong the hospital stay. In addition, it also increases the probability and degree of upper limb (hand) disability "Chen Hongxia said.
Chen Hongxia introduced that the common clinical classification of "hemiplegic shoulder" is shoulder subluxation, shoulder-hand syndrome, shoulder and shoulder soft tissue injuries.
The anatomical causes of hemiplegic shoulder include ligaments, tendons, synovial sac, muscles, joints, bones, and nerve sources.
"The number of patients with central pain and neuropathic pain is small, and more patients have pain due to damage to muscles, tendons, and soft tissues due to improper care or exercise."
Chen Hongxia said that because the shoulder joint is flexible and can move 360 degrees, it is not as strong as a knee joint or a joint that only has flexion and extension functions.
Therefore, after a stroke, patients with shoulder joint subluxation can easily lead to joint subluxation due to low muscle strength, insufficient tension, or spasm, which can stretch nerves, muscles and tendons, and cause later pain.
In the early stage, the patient’s hemiplegic upper limbs should be treated with electrical stimulation and Bobart's manipulation to correct the position of the scapula and restore the original locking mechanism of the shoulder; stimulate the muscles around the shoulder joint to produce muscle tension and active contraction.
On the premise of not damaging the joints and surrounding structures, keep the shoulder joint painless and full range of motion.
For patients who have already experienced pain, the upper limbs on the hemiplegic side should be firmly supported before the above treatments.
"If the patient does not move properly, it is very unfavorable to the recovery of upper limb function." Chen Hongxia pointed out that the placement of a good limb is very important.
The so-called placement refers to the placement of the patient lying, sitting, standing or walking, rather than lying on the bed.
When lying on the bed, the upper limbs of the hemiplegic side should be 90 degrees to the torso; when sitting on the bed, the legs and torso should be 90 degrees; when sitting on a chair, put your elbows on the table, stretch your hands forward, and place your feet flat ground.
When the patient is standing or walking and needs the support of the shoulder support, the shoulder support should be selected according to its dysfunction.
The principle of selection is to hold the upper limbs of the hemiplegic side, make the joints aligned, and the degree of roundness of the shoulder with the shoulder rest is the same as the other side.
Patients who have cramps may need help from family members or some braces for placement.
"It is necessary to monitor the patient's lying, sitting, and standing in an all-round way. We remind patients to pay attention to the position of the upper limbs from beginning to end. It is impossible for doctors and nurses to watch the patient all the time. The attendants, patients, and family members must also pay attention. If you take precautions, Perhaps more than half of the patients will not have pain." Chen Hongxia said.
Patients with shoulder-hand syndrome manifest as shoulder-hand pain, paresthesia, vascular dysfunction, edema, abnormal sweating, and nutritional disorders.
"Shoulder-hand syndrome is an important cause of upper limb disability after stroke. Basically, the hand cannot be held or stretched. If no intervention is performed, the hand may become disabled. We must control it as soon as possible in the first stage." Chen Hongxia Say.
Chen Hongxia introduced that in the first stage of shoulder-hand syndrome, the patient's hand will suddenly become swollen, and soon the range of motion will be obviously restricted.
Edema mainly appears on the back of the hand, the color of the hand is orange-red or purple, especially when the hand is in the pituitary position, there is a slight hot and humid feeling.
The first phase usually lasts for 3-6 months. If actively treated, it can generally improve the condition and control the development.
Without treatment, some people quickly enter the second stage, where shoulder pain, dyskinesia, hand edema are reduced, and vascular motility changes (such as increased skin moisture and redness).
The skin and muscles of the affected hand were obviously atrophy, the fingers were claw-shaped, and the X-ray showed osteoporosis, which was difficult to treat.
If it enters the third stage, the edema and pain disappear completely. Without treatment, the mobility of the hand will disappear permanently, causing permanent sequelae, and becoming a fixed characteristic deformity of the hand.
There is also a common "hemiplegic shoulder" called shoulder and shoulder soft tissue injury.
Chen Hongxia said that after musculoskeletal ultrasound screening of the upper limbs of stroke patients, it was found that 1/3 of the patients had muscle and tendon injuries in the acute phase.
She reminded patients to pay attention to screening and treat as soon as possible.
Chen Hongxia gave the patients a strategy for shoulder pain management and rehabilitation: as long as the patient has upper limb dysfunction, it is necessary to prevent the occurrence of shoulder pain.
“The prevention and management of shoulder pain should follow the doctor’s education, maintain the correct posture, perform physical therapy, and use braces when necessary. Drug therapy, physical factor therapy, traditional Chinese medicine acupuncture, rehabilitation training, etc. are all effective. There is no way. Surgery was performed. Surgery is not the goal, but prevention should be the first priority."
Chen Hongxia specially reminded that most patients with long-term pain are depressed.
If it is estimated that the patient's function cannot be recovered in two or three months, antidepressant treatment should be carried out early, and the patient should be given drugs or psychological counseling, which is very helpful to the patient's mood and treatment coordination.
China Youth Daily·China Youth Daily reporter Zhang Manyu Source: China Youth Daily