How is hemiplegic shoulder pain caused by subluxation treated?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Treatment of subluxation by reduction remains a controversial means of controlling shoulder pain. Slings, arm boards, troughs, and lap trays have not proven to be effective and, in some cases, may result in overcorrection. Sling use also may cause lateral subluxation, impair proprioception, interfere with functional activities, or promote undesirable synergy patterns; furthermore, sling use may not prove beneficial in preventing shoulder subluxation.

Attempts at strapping also have produced variable results. Even though sling use and other supportive devices remain controversial, Yu and coauthors reported that treatment of shoulder subluxation continues to be the standard of care for several reasons, including the following [22, 23] :

  • Painful shoulder subluxation most commonly is present when the upper extremity is in a dependent position; painful shoulder subluxation improves with joint reduction

  • Subluxation may have a role in the pathogenesis of other painful conditions by stretching local neurovascular and musculoskeletal tissues

  • Early prevention is warranted, since chronic shoulder pain often is refractory to treatment

  • Subluxation may inhibit functional recovery by limiting shoulder range of motion (ROM)

Another form of treatment, neuromuscular electrical stimulation (NMES), has proven moderately successful in the prevention and treatment of subluxation. [45, 46] Yu and colleagues demonstrated substantial reduction in subluxation and, possibly, enhancement of motor recovery and reduction of shoulder pain. [22, 23]

However, it is debated whether NMES should be used prophylactically or whether its use should be held until subluxation develops. (NMES is discussed further under Neuromuscular Electrical Stimulation, below.)


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