How to Prevent Shoulder Subluxation After Stroke

Shoulder subluxation refers to a partial dislocation of the shoulder joint. It occurs when the humerus partly or completely comes out of the glenoid socket in the should. It is a common secondary limb dysfunction in stroke patients with hemiplegia, which will affect the recovery of upper limb function and lead to shoulder pain in severe cases. The incidence of shoulder subluxation in stroke patients is 17%-81%, and most of them are within 3 months after stroke.

Why stroke patients have shoulder subluxation

Due to the paralysis of the affected limb, the muscles around the shoulder joint do not have enough strength to fix the humeral head in the glenoid. In severe cases, the weight of the arm itself can cause the humeral head fall out of the glenoid. Arms may also be accidentally pulled out by caregivers while helping them transfer, bathing, and dressing.

How to prevent shoulder subluxation after stroke

1. In the early stage of stroke, we should avoid pulling hard on the shoulder joint of patients. Measures such as local transcutaneous electrical stimulation, shoulder joint protection can be carried out to prevent shoulder subluxation.

2. Excessive shoulder flexion and abduction movements and shoulder pulley exercises with hands raised over the head should be avoided, which can lead to uncontrollable shoulder abduction and shoulder pain.

3. Patients with significant hand swelling can be treated with topical compression devices, which are beneficial in reducing end-limb swelling.

4. For stroke patients with severe muscle weakness and who are at risk for shoulder subluxation, electrical stimulation combined with traditional exercise therapy is recommended to reduce the incidence of shoulder subluxation.

Applying low-frequency pulse current(Neuromuscular Electrical Stimulation, NMES) to stimulate shoulder stability muscle group, especially the supraspinatus and posterior deltoid muscles can exercise muscle. The use of electrical stimulation at an early stage can prevent shoulder subluxation. Here is a guide on how to place the electrode.

5. For patients with shoulder subluxation, it is recommended to use a firm support device to prevent deterioration. Continuous shoulder position maintenance training can mitigate shoulder subluxation.

The best way to protect your shoulder is to make sure you always have item to support the weight of your arm to keep it from falling. For example, use pillows to support arm weight while sitting, use shoulder stability brace to support arm weight when standing and walking. When choosing shoulder brace, the brace that aggravates spasm mode should be avoided.

The prevention of shoulder subluxation is very important. Once shoulder subluxation occurs, its treatment strategy is to prevent further deterioration. Local shoulder support devices, percutaneous electrical stimulation, and continuous shoulder position maintenance training are beneficial to the prevention and treatment of shoulder subluxation.