Evaluation and Treatment of Shoulder Subluxation in Hemiplegia

Abstract

Shoulder subluxation in hemiplegic patients has been recognized as a difficult problem to manage. In the study contained herein, our aims are to evaluate shoulder subluxation, to clarify if shoulder subluxation causes pain, and to discuss the treatment of shoulder subluxation. The study included 75 hemiplegic patients with shoulder subluxation. Each patient was evaluated for the degree of shoulder pain, motor recovery of the upper limb, and shoulder range of motion. Some indexes for evaluating subluxation were measured with radiographs of the shoulders. Arthrograms of the affected shoulder joint were taken in 23 patients. The following results were found: (1) shoulder pain was significant more frequently in left hemiplegia; (2) vertical disparity was strongly correlated with discrepancy of the descendant ratio; (3) severe inferior subluxation had a tendency to show medial displacement of the humeral head; (4) there were correlations between shoulder pain and shoulder range of motion, especially external rotation; (5) adhesive changes in the arthrograms were seen in most subjects. These results indicate that there is no relation between shoulder subluxation and pain, and adhesive capsulitis is a main cause of shoulder pain. We conclude that correct positioning and shoulder range of motion exercises are advisable in hemiplegic patients with shoulder subluxation.

MRI Findings in the Painful Poststroke Shoulder

“…5 These clinical entities, however, are likely end products of a complex cascade of events initiated by the biomechanical compromise of the poststroke glenohumeral joint. 6 Although arthrograms have been used to evaluate structural abnormalities in the painful poststroke shoulder, [7][8][9][10][11][12] the results of these studies have been inconsistent.…”

A Study of the Clinical Utility of the BPI-12 and 23 in Predicting Shoulder Pain in Stroke Patients

“…Lo et al 8) revealed eleven causes of shoulder pain when they examined patients within two months after stroke using arthroscopy. According to their study, 50% of the patients suffered adhesive capsulitis, and the incidence rate within one year reached 74% 9) . In a stable condition, shoulder pain showed a significant correlation with the joint range of motion of the affected shoulder external rotation 3) , and the affected shoulder external rotation is related to the time (r=-0.538) since stroke attack 8) .…”

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

“…[6][7][8][9][10] Current clinical methods include palpation, the number of finger-breaths, and use of thermoplastic jigs. However, these clinical methods are physician-dependent with low sensitivities.…”

“…Although radiographs have high reliability and validity, they have some disadvantages such as high cost, and being time-consuming and radiation exposure. [8][9][10][11] On the other hand, musculoskeletal ultrasonography (USG) has several advantages (i.e., inexpensive, convenient, dynamic, radiation-free) over direct radiographic imaging, and it is widely used for musculoskeletal conditions, particularly in the shoulder region. [12,13] Furthermore, it has been shown to be a valid and reliable method for the assessment of the GHS in post-stroke patients.…”