Studies show that most patients who suffer hemiplegia after stroke have shoulder subluxation. With incidences higher in severely-paralyzed patients, shoulder subluxation is one of the most common secondary muscoloskeletal problems after stroke. Shoulder subluxation, nevertheless, can be treated in various ways.
Also referred to as instability, a shoulder subluxation involves the partial dislocation of the shoulder joint wherein the ball of the upper arm bone slips partially out of the shoulder socket due to spastic muscles pulling the humerus and shoulder blade into abnormal positions.
Treatment involves the use of heat or ice packs, pain medications, support devices, and shoulder strapping to reduce the pain plus various therapies like prolotherapy, closed reduction, hydrotherapy, acupuncture, electrotherapy, occupational therapy and muscle toning-strengthening exercises.
1. Closed Reduction and Immobilization through supportive devices
Closed reduction is a medical procedure wherein the head of the humerus is put back into place by applying a traction to the arm. Afterwards, immobilization takes place through the use of supportive devices for four weeks to prevent the arm from moving. Supportive devices like shoulder cuffs, slings, and braces prevent trauma during ambulation but prolonging their use can cause immobility and encourage spasticity.
2. Prolotherapy
Prolotherapy is a medical procedure imploring natural treatment wherein solutions are injected into the affected ligaments, tendons, and joints to stimulate an inflammatory reaction in the body, which in turn, heals the subluxation.
3. Electrotherapy
Functional electrical stimulation and cyclical electrical stimulation of the shoulder muscles reduce subluxation but prevents it only if treatment is continuous.
4. Exercises
Exercises vary per patient as shoulder exercises are not for those with a history of shoulder dislocations prior to their post-stroke shoulder subluxation to avoid further dislocation. To relax muscles which are too tight, girdle and scapular muscle strengthening exercises are recommended for patients with recurring shoulder dislocations. Weight bearing exercises, rotator cuff strengthening exercises, and shoulder musculature strengthening exercises are often applied to most stroke patients with shoulder subluxation. Remember, it is important to implore a gentle, unexaggerated range of motion each time the patient is exercised.
5. Proper positioning
Proper positioning involves maintaining the correct posture while sitting, lying in bed, or doing daily activities. Always remember to carefully transfer, position, and assist stroke patients in daily activities as these are also preventive measures to stroke subluxation:
- The affected arm must never be pulled or used as a lever to aid transfers
- Arms should be supported on a surface to keep shoulder joints intact while sitting with a lap board or tray or pillows
- Never lift under the arms when helping patients to move in bed and get up in bed or chair
- Put affected arm through sleeves first and then the unaffected arm when dressing and vice versa when taking the shirt off (first in last out).
Treating post-stroke subluxation is possible though it may take time. Prevention is the still best way to avoid this from happening, which caregivers have a big role to play in.
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