What is Shoulder Subluxation?
Shoulder subluxation can be defined as partial or incomplete dislocation of the glenohumeral joint or translation. It happens between the humeral head and glenoid fossa with the humeral head still remaining in contact with the glenoid fossa. Unfortunately, shoulder subluxation is commonly seen on the affected side of a stroke patient. It is because the structures that support the shoulder joint integrity is weakened or dysfunctional. This occurs most commonly in the rotator cuff muscles.
During the initial period following a stroke, the hemiplegic arm is flaccid or hypotonic. The shoulder muscles are unable to hold the humeral head within the glenoid cavity, resulting in higher risk of shoulder subluxation.
Hence, proper support on the effected extremity is needed as the weight of the arm against gravity may cause further subluxation. Preventing the patient from hanging their arm by the side when they are in a vertical position is a good example.
What can be done to prevent shoulder subluxation?
Shoulder brace
Shoulder support or orthosis such as Bobath, Rolyan humeral cuff, or standard hemi sling may reduce the subluxation. To prevent further subluxation in stroke patients, supporting the hemiplegic limb in the proper position is crucial.
Positioning
Utilizing pillow or foam cushion to position the hemiplegic shoulder in order to keep the arm and shoulder supported in the correct position. In lying position, caregiver can place pillow beneath the shoulder and elbow of the hemiplegic arm. Encourage the patient to always place the affected arm on their lap instead of hanging the shoulder on the side of the chair when they are in vertical position.
In fact, proper support on the effected extremity is needed as the weight of the arm may cause the subluxation to worsen.
Handling technique
Caregivers and family members need to be informed of certain precautionary measures when handling patient’s hemiplegic arm or it may cause traction neuropathy and injury. For instance, caregivers can hold on the armpit of the patient while changing their position. Avoid pulling from the arm to lift up the body as it will put strain on the ligaments and further damage the shoulder joint.
Facilitation of movement
In the early stage of rehabilitation, early physiotherapy management such as active assisted movement has been shown effective to prevent shoulder subluxation. Besides, weight bearing exercises for the shoulder is essential for stroke patients to regain neuromuscular function.
References:
1. Arya, K., Pandian, S., Vikas and Puri, V., 2017. Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review. Topics in Stroke Rehabilitation, 25(1), pp.68-81.
2. Murie-Fernández, M., Carmona Iragui, M., Gnanakumar, V., Meyer, M., Foley, N. and Teasell, R., 2012. Painful hemiplegic shoulder in stroke patients: Causes and management. Neurología (English Edition), 27(4), pp.234-244.
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