Current and Future Interventions for Glenohumeral Subluxation in Hemiplegia Secondary to Stroke

Abstract

Poststroke shoulder pain is a common issue and can be caused by glenohumeral subluxation. This entity hinders function and quality of life and is caused by changes in tone and loss of fi ne control of the shoulder joints' supporting structures after a stroke. Current treatments are limited in number and effectiveness and have significant problems and limitations to their use. Furthermore, prior to percutaneous implantable neuromuscular electrical stimulation, there was no evidence for any treatment to provide relief for chronic hemiplegic shoulder pain from glenohumeral subluxation. This clinical review provides a comprehensive review of the anatomy, pathogenesis, clinical features, management, and clinical efficacy of current treatment modalities.

Upper Limb Rehabilitation Following Stroke: Current Evidence and Future Perspectives

“…Rates of subluxation have been variably reported in the literature, with incidence ranging from 17-64% [100]. Correlation between subluxation and development of hemiplegic shoulder pain remains controversial, with reviews of literature not concluding a causative association [101].…”

“…Supportive devices have not been demonstrated to prevent subluxation, though remain recommended in treatment of established subluxation [204]. Electrical stimulation is advocated in prevention, but has not been demonstrated to reduce actual measures of subluxation [100].…”

“…A paper assessing correlations between upper limb function and the ICF model found shoulder pain to be the variable most associated with limitations in participation [101,103]. This area is an important focus of future research as up to 20-30% of patients experience pain refractory to current treatment modalities [100].…”

Ultrasonographic assessment of neuromuscular electrical stimulation efficacy on glenohumeral subluxation in patients with hemiplegia: a randomized-controlled study

“…[1] It mostly occurs in hemiplegic patients as an inferior subluxation with an incidence of 17 to 81%. [2][3][4] Supraspinatus and posterior deltoid muscles contribute to the shoulder stabilization, and they prevent the inferior subluxation.…”

“…[2][3][4] Supraspinatus and posterior deltoid muscles contribute to the shoulder stabilization, and they prevent the inferior subluxation. [1] Severe impairment of motor function, particularly in these muscles, after stroke is a potential risk factor for subluxation. [5] Shoulder subluxation interferes with the daily life activities due to impaired upper limb motor function, which may prolong the rehabilitation process.…”