A shoulder subluxation is a result of severe shoulder instability after a stroke. This can cause pain and have a negative impact on regaining active shoulder movement.
What is a stroke shoulder subluxation?
A shoulder subluxation is when the arm bone (humerus) partially falls out of the socket.
What causes a shoulder subluxation after a stroke?
Without having adequate strength in the muscles that hold the arm bone in the shoulder socket, unfortunately, it is pretty easy for it to just “fall out”. In severe cases, just the weight of the arm can cause it to drop out of the socket. The arm can also be accidentally “pulled” out by a caregiver while they are helping with transfers, bathing, and/or dressing.
How do you prevent a shoulder subluxation?
The best way to prevent a shoulder subluxation is to make sure to always have a way to support the weight of the arm (to prevent it from “falling out”).
Positioning the arm in sitting
When sitting, you want something to support the entire arm. Pillows are a great way to achieve this. In most cases, a wheelchair arm rest is not adequate. It is usually to narrow and in most cases, the arm will fall off and cause the arm to sublux (partially dislocate) from the shoulder joint.
Positioning the arm in standing
The best sling on the market is the givemor sling. It is great for anyone who has a very “limp” or flaccid arm. It is not ideal for someone who has spasticity in the arm. This sling supports the weight of the arm while not interfering with normal arm swing.
Traditional Shoulder Sling
A sling is not the best choice as this encourages disuse and can create muscle shortening in the pectoralis muscles and the latissimus muscles which can interfere with movement retraining. That being said, an arm sling IS beneficial for transfers to protect the shoulder joint but should be removed once when seated or laying down.
What is the treatment for a shoulder subluxation?
Strengthening is the best treatment. Here is a video where you can learn more arm strengthening exercises
Weightbearing is sometimes an effective way to “wake up” some of the shoulder muscles. Weightbearing also helps to approximate the arm bone in the joint. In this video, you will learn more about how to perform a weightbearing exercise after a stroke