Help with trousers for man with severe arm pain
Peter Hodson of the Harrogate panel would be very grateful for advice on the following challenge. His client is 64 years old and came to them with compression of the cervical vertebrates. He had these decompressed and the cause of this is being investigated. His OT has asked the panel to try to help him overcome dressing difficulties.
Functionally, the client is able to shrug his shoulders, but is having extreme difficulty elevating his shoulders, and therefore he is having difficulty putting on his t-shirts as he can’t lift his arms high enough without having severe pain. He is also having difficulty pulling up his trousers, due to the same problem, and he has started to wear jogging bottoms to make pulling up easier. However, he prefers to wear jeans due to personal preference and also because his arms dangle when he walks, which is causing pain, and when wearing jeans he can tuck his hands around the belt which reduces his pain. He can’t do this with jogging bottoms as they are too loose to support his arms.
The OT had hoped the device at this link would help http://www.able2.eu/catalogues/ADL/12-Mobile-Arm-Support.pdf but it didn’t as even this device was too painful for him to use. She is wondering about a girdle-type device which he could wear with jogging bottoms which would support his arms.
So the 3 problems are:
1. lifting arms into t-shirts
2. pulling up trousers
3. reducing shoulder pain by de-weighting upper limbs.
If anyone has any thoughts on this, please enter them below or email Peter direct on phodson@slsconsult.co.uk.
- Skills involved:
- Issues Addresses:
- Activities Helped:
- Location:
- Solution:
2: There is a dressing aid by the Helping Hands Company that is similar to the sock aid. There are two big clothes clip type clips on the end of some straps and you clip them to your trousers and throw the trousers on the floor and pull up on the straps. I tried looking for them but I can’t find them on their web site. It might be worth calling them about it.
3: He can wear a hoodie and place his arms in the front pocket of the hoodie.
If wearing a sling around the neck is too painful, this might be an alternative. I did try and find ones for twins but they seem to only come as a single. He could rest his arm on it.
http://www.amazon.co.uk/Hippychick-HIP001-Hipseat-Black/dp/B000NI2YEE/ref=sr_1_1?ie=UTF8&qid=1369914353&sr=8-1&keywords=baby+hip+seat
It is unusual for someone who has had a cervical decompression to be left with severe pain: numbness and/or weakness are much more likely, see
http://www.nbt.nhs.uk/sites/default/files/filedepot/incoming/Information%20for%20patients%20undergoing%20Cervical%20surgery.pdf
I’m wondering whether the problem isn’t really arthritis of the shoulder deserving investigation on its own account. Anyway, it is not easy to help without knowing how far the client can reach in all directions, and how hard he can pull from all directions without it hurting.
If the tee shirt is laid on a table he can try reaching forward to get his arms into it, and then dipping his head into it. This might be less painful than having the arms vertical. However, anatomically the position at the shoulder is the same as if he was standing up, and if the pain comes from the shoulder it would be no different. Ultimately a buttoned shirt would be easier.
For the jeans, I wonder about using the manoeuvre that girls used to employ to get skin-tight jeans on – get the jeans as far as the knees, lie down on a bed with the legs in the air and pull downwards. That would get the jeans to near the waist, and he could then sit up to complete the pull.
From Dr. Jeffrey Lesser
A broad belt would allow him to tuck in his thumbs and take the weight off
his arms.
As an experiment, it would be worth trying him with the belt or a similar
to fix his arms to his sides. He might by flexing his head with his chin
on his chest, be able to manipulate the T-shirt with his lower arms, only
moving the elbow joints and not the shoulders.
If he is able to put his trousers on and pull them up to his knees while sitting down and then if there is a chair or other item of furniture firmly secured, elevated to just above waist height, accessed with a step, that he could sit on, then hook a belt loop each side of the trousers onto suitably positioned hooks, then he could perhaps slide off this chair/furniture onto the floor thereby pulling up the trousers. Of course this would only be safe if he has sufficient agility in his legs.
Wearing ordinary shirts with buttons would eliminate the need to raise his arms to put on T-shirts.
You would need a competent dressmaker, but he could have his clothes adapted and fitted with velcro for opening and closing. An example would be to open the jeans down the outside seams and sew velcro to each side. This would allow him to “sit” into them and then fasten the sides by pressing the velcro tapes together. It would depend how far he could pull the jeans up as to how far down the seams need to be opened.
A pair of slings might help with the shoulder pain although would look rather unsightly – see http://www.pimpmycast.co.uk/adult-products-s/1819.htm or http://www.posture-support.co.uk/acatalog/arm_slings.htm However, you can make something similar…for one sling you need a length of the foam/jersey material used in A&E for temporary slings. Measure from his elbow, behind and diagonally across his back, over his shoulder and down to the wrist held at a 45degree angle to the waist, plus 20″. Firmly sew two 10″ loops at each end. The elbow goes into one loop, the sling passes behind the arm, diagonally across the back, over the opposite shoulder and down to the waist where the hand can be inserted into the other loop and is supported at the wrist.