Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review

Abstract

Background Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke subjects. The pathomechanics at the skeletal level does not provide the structural base for the neural-motor recovery. The management of subluxed shoulder has always been a challenge, complicating the motor and functional recovery. Objective To review the available studies of rehabilitation interventions for reduction of subluxed shoulder and to explore the evidence for impact of subluxation on motor recovery. Method PubMed, the Cochrane Central Register of Controlled Trials, DORIS, PEDro, and OTseeker databases were searched using the keywords: Stroke and Shoulder and Subluxation. The experimental, quasi-experimental, and single group studies investigated the rehabilitation methods to reduce the subluxation were selected. A narrative synthesis of the findings from the selected studies was carried out. Result 2717 studies were identified and 22 studies (14 RCTs or controlled trials and 8 pre-post-single group studies) were finally selected for the review. The rehabilitation intervention: Functional electrical stimulation (FES)/electrical stimulation (11), orthosis/support (07), taping (02), and robotic training and other methods (02) were reviewed. FES is effective in reducing subluxation in acute stage. Shoulder support or orthosis while in situ may reduce the subluxation temporarily. X-ray was the most commonly used assessment tool for the subluxation. Implication of the rehabilitation technique on motor recovery has not been investigated. Conclusion No technique could effectively reduce the subluxation and facilitate the upper limb recovery. Further studies integrating the usual motor training and the subluxation rehabilitation are warranted. Future trials using more precise and valid tool such as ultrasonography are also needed.

A comparative study to assess the satisfaction with clinical outcome of the patients suffering from hemiplegic shoulder subluxation and undergoing rehabilitation with and without Bobath shoulder sling

“…10 This finding was also supported by Paci et al, Jung et al, Nadler et al, Arya et al, suggesting the use of shoulder support should be restricted for a limited period in early stages of stroke and once sufficient motor recovery is achieved around shoulder girdle, it should be discontinued. [4][5][6]8 Sample size was small. Outcome difference between different types of strokes, different age groups and gender were could not be compared.…”

Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study

“…Shoulder subluxation (SS) or glenohumeral subluxation is one of the common complications in poststroke setting, with an incidence of approximately 17%-81% [1,2] . After a stroke, the hemiplegic upper extremity (HUE) could be affected by muscle weakness, gravity traction, incorrect posture transfer, or peripheral nerve/rotator cuff injury, so the humeral head partially detaches from the glenoid, which leads to the SS [1,3] . After a SS, the shoulder joint capsule, the surrounding tendons and the brachial plexus nerves could be pulled by the HUE [4,5] .…”

“…After a SS, the shoulder joint capsule, the surrounding tendons and the brachial plexus nerves could be pulled by the HUE [4,5] . Then, the degree of SS and upper limb dysfunction could be further aggravated [1,3] . Electrodiagnosis and ultrasound medicine studies show that, in post-stroke patients, the peripheral nerves of the HUE could exist different degrees of impairment which seriously delays the function recovery of the HUE [6][7][8] .…”

Impact of Shoulder Subluxation on Peripheral Nerve Conduction and Function of Hemiplegic Upper Extremity in Stroke Patients: A Retrospective, Matched-Pair Study

“…After a SS, the shoulder joint capsule, the surrounding tendons and the brachial plexus nerves could be pulled by the HUE [4,5] . Then, the degree of SS and upper limb dysfunction could be further aggravated [1,3] .…”