What are the treatment options for limited abduction, flexion, and extension of the Left Upper Extremity (LUE)?

Treatment of Limited Abduction, Flexion, and Extension of the Left Upper Extremity

The primary treatment approach is task-specific practice (repetitive task-oriented training) to restore motor function, supplemented with neuromuscular electrical stimulation and mirror therapy as adjunctive interventions. 1

Core Rehabilitation Strategy

Task-Specific Practice (First-Line Treatment)

• Engage in repetitive, goal-directed functional activities that promote normal movement patterns, proper alignment, and even weight-bearing 1
• Focus on activities of daily living such as reaching, grasping, and manipulating objects to directly address the limited range of motion 1
• Gradually increase active range of motion in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle 1
• Use bilateral tasks when appropriate, incorporating the affected limb to avoid learned non-use 1

Range of Motion Restoration

• Treatment should include gentle stretching and mobilization techniques, typically increasing external rotation and abduction gradually 1
• Active range of motion exercises should be performed to prevent contractures and complex regional pain syndrome 1
• Avoid positioning joints at end-range for prolonged periods (e.g., full flexion while sitting) 1

Adjunctive Therapeutic Interventions

Neuromuscular Electrical Stimulation

• Apply neuromuscular electrical stimulation as an adjunct to conventional therapy to improve upper extremity motor function 1
• This modality has stronger evidence support than other electrical stimulation approaches 1

Mirror Therapy

• Implement mirror therapy to improve motor outcomes and activities of daily living 1
• This technique can also address unilateral spatial neglect if present 1

Movement Facilitation Techniques

• Encourage optimal postural alignment at rest and during function using a 24-hour management approach 1
• Promote even distribution of weight in sitting, transfers, and standing to normalize movement patterns 1
• Use gross movements rather than fine movements initially, as these require less concentration 1
• Discourage "nursing" of the affected limb; instead demonstrate therapeutic resting postures 1

Important Clinical Considerations

What to Avoid

• Do not use splinting as a first-line intervention, as it may increase attention to the area, promote compensatory movements, cause muscle deconditioning, and lead to learned non-use 1
• Avoid immobilization strategies that prevent restoration of normal movement patterns 1
• Do not encourage muscle co-contraction or tensing as a compensatory strategy 1

Pain Management (If Present)

• If shoulder pain limits participation, use analgesics such as acetaminophen or ibuprofen when not contraindicated 1
• For spasticity-related pain, consider botulinum toxin injections into subscapularis and pectoralis muscles 1
• Subacromial corticosteroid injections may be appropriate if pain relates to rotator cuff or bursal inflammation 1

Monitoring and Progression

• Video recording interventions (with consent) can demonstrate changeability, highlight successes, and serve as reference points for strategy replication 1
• Grade activities to progressively increase the time the affected limb is used within functional tasks 1
• Employ anxiety management and distraction techniques during task performance 1

Insufficient Evidence Interventions

The following have insufficient evidence but may be considered on a case-by-case basis:

• Constraint-induced movement therapy (requires at least 10 degrees of active extension in fingers, thumb, and wrist) 1
• Aquatic therapy compared to land-based therapy 1
• Biofeedback, motor imagery, or acupuncture 1