1423 - The New Modified Spencer Technique for Hemiplegic Shoulder Pain

Case Diagnosis: Introduction of a new modified Spencer technique for hemiplegics shoulder pain

Case Description: A 57-year-old female presents with right hemiplegic shoulder pain two weeks after her cerebrovascular accident. During the patient’s acute inpatient rehabilitation, the patient was trialed with physical modalities, lap board, rehabilitation techniques, and pharmacologic agents (gabapentin and acetaminophen) with minimal shoulder pain relief.

The patient was then examined with an osteopathic palpatory diagnosis documenting specific somatic dysfunctions by finding palpable tissue texture changes, asymmetry to motion, passive range of motion deficits, and tenderness. The patient underwent new osteopathic manipulative treatment, a Modified Spencer technique for her right hemiplegic shoulder pain. The modified technique included most of the stages, except for stage 4 and 7, where compression to the shoulder was applied instead of traction and distraction. After three sessions of the Modified Spencer technique, the patient’s right hemiplegic shoulder pain improved from 9/10 to 1/10 on pain visual analog scale. The patient’s right upper limb spasticity also demonstrated an improvement.

Discussions: Hemiplegic shoulder pain is a common problem among people with stroke. The use of osteopathic manipulative medicine is often overlooked and underutilized in the treatment of hemiplegic shoulder pain. We performed a modified Spencer technique, where two stages are modified in order to safely treat the hemiplegic shoulder. At stage 4 and 7, traction and distraction of the Spencer technique are normally performed, however, the modified technique incorporates compression to shoulder in order to accommodate the patient’s shoulder pathology. Hemiplegic shoulders generally have some degree of subluxation. Adding traction or distraction to the shoulder with the traditional Spencer technique can lead to further subluxation and injury to the shoulder.

Conclusions: This new Modified Spencer technique provides a safer, noninvasive and supplemental approach to traditional hemiplegic shoulder pain management.