Vita TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
When we think of burn injuries in terms of their impact on function and quality of life, hand burns usually first come to mind. But it’s also important to remember that dexterous hand operation requires sufficient mobility and stability of the shoulder joint. Also, good shoulder joint ROM is required to smoothly carry out many activities of daily living in an independent manner. Therefore, we shouldn't underestimate the impact of burns on shoulders.
Burn injuries can significantly impact shoulder joint. According to Webb DC et al. (2011), the axilla is the site most prone to contracture among adult burns. Nearly 1/4 of these patients require reconstructive surgery to improve scar contracture issues [1]. But even when burns are not located directly on or around the shoulder joint, scars elsewhere on the body or other post burn issues (like bad posture) can still affect ROM. In this article, we discuss the importance of shoulder function to provide effective rehabilitation of the burned shoulder and the challenges therapists face.
Anatomy of the Shoulder Joint
The shoulder joint is a complex structure involving the clavicle, scapula, and humerus, forming the glenohumeral joint, acromioclavicular joint, and sternoclavicular joint. This highly mobile joint allows movements in almost every axis. The movement of the scapula plays a crucial role in the overall movement of the shoulder joint, with coordinated rhythm between scapulothoracic and glenohumeral movements enabling full elevation of the upper limbs. This coordination, also called scapulo-humeral rhythm, is essential for good shoulder function.
Factors Leading to Abnormal Shoulder Movement Post-Burn
Abnormal shoulder movement after burns can arise from three primary factors:
Immobilization: Causes changes in soft tissue.
Excessive Use of Compensatory Movements: Leads to muscle imbalance.
Scar Contracture: Changes soft tissue and may lead to muscle imbalance.
These factors can result in movement restrictions due to contracture or abnormal scapulohumeral rhythm, affecting overall shoulder joint movement.
Challenges for the Rehabilitation of the Burned Shoulder
Complexities of Shoulder Movement Evaluation and Intervention
The posture of the neck, chest, and waist can influence shoulder joint movement, adding to the complexity of evaluation and intervention.
Pressure Therapy Difficulties
The shoulder's structural complexity, with its flat surfaces, curved surfaces and concave areas, makes providing even pressure through pressure therapy challenging. For example, it is very difficult for pressure garments to provide constant and even pressure in the axilla area. Also, the wide range of motion of the shoulder also affects the stability of pressure garments.
Splinting Difficulties
Although splints can be used to position the shoulder, discomfort, impact on walking and upper limb functions, and aesthetic concerns can make their use difficult for patients.
Importance of Shoulder Function in Burn Rehabilitation
Given the complexity of the shoulder joint, and challenges for evaluation and interventions, it is crucial not to overlook it in rehabilitation. A study on factors affecting return to work after burn injuries highlighted that involvement of the shoulder in the injured area significantly impacts return to work [2]. This underscores the importance of shoulder function in overall functional performance.
Conclusion
Effective rehabilitation of the burned shoulder is essential for improving patients' quality of life and functional performance. By addressing the complexities of the shoulder joint and providing targeted interventions, therapists can significantly aid in their patients' recovery.
Comprehensive Courses on Rehabilitation of the Burned Shoulder
Now that you understand the critical role of shoulder function in burn rehabilitation, you may think: So, what should I do next to improve my knowledge and skills for managing the burned shoulder?
We offer a series of courses designed to address shoulder problems post-burn. These two series of courses cover in detail basic knowledge, as well as practical clinical considerations for managing shoulder burns:
Detailed anatomy of the shoulder
In-depth introduction to scapula-humeral rhythm
Common post-burn shoulder issues
Evaluation of the burned shoulder
Treatment interventions: Exercises
Treatment interventions: Pressure therapy
Treatment interventions: ADL training
Be sure to check out our course schedule for upcoming course dates.
References:
Webb DC, Byrne M, Kolmus A, Law HY, Holland AE, Cleland H. Outcomes of a shoulder treatment flowchart in patients with axillary burns. J Burn Care Res. 2011 Mar-Apr;32(2):224-30. doi: 10.1097/BCR.0b013e31820aaeda. PMID: 21336045.
Tolentino-Bazán K, Chavez-Heres T, Morales-García M, Macías-Hernández SI, Ramírez-Ramírez AC, Velázquez-Bustamante AE, Rhoades-Torres GM, Velez-Palafox M. Predictive Factors for Returning to Work in Burn Adult Patients That Were Working Before Their Injury. J Burn Care Res. 2021 Mar 4;42(2):294-299. doi: 10.1093/jbcr/iraa140. PMID: 33128060.
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