What is the role of a sling in the prevention of hemiplegic shoulder pain?

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

Answer

Slings often are used early poststroke in an attempt to prevent subluxation. Cailliet has contended that it continues to be the best method for supporting and protecting the hemiplegic shoulder while the patient is standing or transferring. [10] However, excessive sling use should be avoided due to the increased incidence of contractures.

Kirshblum has proposed that the following considerations be used when deciding on the use of a sling [77] :

  • Proper fit that promotes proper glenohumeral alignment (poor alignment can contribute to increased flexion synergy)

  • Protection of the flaccid extremity during transfers, standing, and ambulation (slings can interfere with balance, however)

  • Should not interfere with patient function

  • Should be relatively easy to don and doff

  • Should not create new problems (eg, edema in the dependent hand), contribute to synergy patterns, or cause scapulohumeral malalignment

Zorowitz and colleagues tested 4 different shoulder sling models for their efficacy in correcting subluxation in stroke patients and found that the only sling that significantly corrected vertical asymmetry was the single-strap hemisling in 55% of subjects, while total asymmetry was corrected most by the Rolyan support in 45% of subjects. [78] They contend that lateral displacement of the humeral head does not appear to be an inherent quality of subluxation, but the use of certain slings, especially the Bobath and Cavalier supports in this study, were found to contribute.

Brooke and coauthors found that the hemisling gave significantly better vertical correction compared with the Bobath sling, while the arm trough/lap board tended to overcorrect. [79] Their results also showed that the Bobath sling horizontally distracted the glenohumeral joint significantly more than the other 2 supports. Even though improved glenohumeral asymmetry was found in some cases, none of the slings consistently prevented subluxation in all cases.

Yu and colleagues also described the propensity of slings to contribute to the deleterious effects of joint immobilization and their promotion of undesirable synergy patterns. [22, 23] For this reason, no consensus has been reached amongst researchers or clinicians as to which model should be used to attain a particular therapeutic goal, or if they should be used at all.


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