subluxed shoulder Rx

[mumujen]

Is that any effective Rx for subluxed shoulder in TBI/ stroke patients?

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[drgkkishorein]

dear mumujen.i am g k kishore.i have finished my master of physiotherapy with specialisation in neurology.i have been working on prevention of shoulder subluxation in stroke patients past 3 years. i have reviewed sufficient literature on this topic.to my knwledge the answer for Rx of shoulder subluxation lies under the mechanical changes which were happening in shoulders of stroke patients.
1.during the early stage of stroke there will be flaccidity
2.there will not be sufficient strength around the shoulder of the affected side,
3.but the weigt of the upper limb hangs on the soft tissues around the shoulder, includes capsule,ligaments & on tendons of the supraspinatus,infraspinatus,teres minor.
4.as these are visco elastic structures,after a point they loose their elasticity and becomes plastic.thus shoulder subluxation appears,and cannot be repaired permanantly
5.but to my experience we can prevent sholder from further subluxation,and also by using facilitatig techniques we can initiate sufficient amount of tone in the rotator cuff muscles which can effectively hold the head of humerus in the glenoid cavity.
6.infact i have fabricated a sling which can effectively prevent shoulder subluxation in shoulder subluxation.i have already presented it in a state wide conference
further discussions will be after your reply

[perfphysio]

Anatomically the shoulder capsule (superior glenohumeral lig) unwinds in internal rotation, thus adding to subluxation in the joint. Some studies are being done using muscle stim. to the external rotators in the flaccid shoulder to see if this can help prevent subluxation during a flacid period initially post CVA. I am not aware of any literature written on it.

Often we need to question whether the subluxation causes discomfort or whether the flaccid shoulder had been damaged during manual handling of the client? This may often be the case and would support the administration of a supportive device if nothing more than to say...."Hey I have a shoulder issue....please be careful"... :-)

[dskphy]

i am a physio working in a multi-speciality hospital. we have started a trial on shoulder subluxation-taping versus bobath/ hemi sling...will keep the forum updated about the developments.