✅ SHOULDER SUBLUXATION
It is the most Commonest condition associated with Cerebrovascular Accident, CVA, and mostly seen in the hemiplegic upper extremity.
It is characterized by inferior displacement of the glenohumeral joint, creating a separation between the humeral head and the glenoid fossa. This is due to weakness in the Shoulder stabilizers, following the disconnection of the hemiplegic side of the body from the brain in terms of motor activities.
Shoulder Subluxation post stroke is more evident by the presence of sulcus sign.
This is where there is a more obvious dimple on the upper part of the deltoid muscle of the affected arm.
Huge percentage of the complication is directly linked to the pull from gravitational force and poor handling of the stroke patient during transfers. In the area of gravitational force, the effect of gravity on the arm is basically in the inferior direction. As a result, the reduction in the strength of the Shoulder stabilizers, make them unable to neutralize the strongest inferior pull from gravity and consequently, the arm bone is inferiorly displaced gradually, in erect positions (Sitting & standing), especially if immediate solution is not accomplished.
Regarding the poor handling too, most relatives wrongly holds on both arms in their attempt to bringing the pt into sitting, or standing positions or during transfers. Owing to this, the shoulder stabilizers have minimal strength to stabilize the glenohumeral joint on the affected side, and the resultant effect will be inferior displacement of the arm bone causing this commonest complication.
➡️ IMMEDIATE INTERVENTION
❌Avoid pulling on the affected when transferring the pt.
✅Rest the arm on your shoulder (Especially when you are assisting the pt to walk) Better,keep the arm under your armpit whilst transferring the pt
Additionally,there are other techniques which can be adapted to properly lift and transfer the patient without causing any pull on the affected arm as demonstrated in figure 4,5 & 6.
✅Hold pt from the armpits all the time during transfers.
✅ Immediate recommendation of arm sling will be helpful to minimize the risk to developing Subluxation in the Stroke Patient
✅ Application of Kinesio tape in a special way, will also provide same effect as the arm sling.
✅ Providing adjustments to the affected arm in sitting and lying
Physiotherapist 