Shoulder instability and balance

I recently assessed a 28 year old man with L shoulder dislocations. This started 4 years ago following a fall onto the shoulder. He underwent a stabilisation op last year which was unsuccessful. 3 months ago, he suffered a right parietal infarct, with left sided hemiparesis. He is now mobile with a walking stick and has been referred to me for further rehab.

Since the CVA, his shoulder dislocates up to 50 times a day, which he relocates himself. He has used a poly sling, brace, and "bobath style" sling, but a specialist (pt cannot recall who and there is no record in med notes) has told him it is not appropriate and not to use them. He is currently awaiting an orthopaedic review in 1 month. I am seeing him to increase his balance and independence, but with his instability, any movement at the shoulder causes dislocations. This is limiting rehab as i am unable to truely challange his balance.

Does anyone have any ideas or suggestions for how to work around this. I am not treating his shoulder, just balance and mobility.

Thanks

Hi Kate671

50 x a day! that is really dreadful. Poor guy. I can understand it is really difficult to do much mobility and balance wise if his shoulder is just so unstable.

Is there a pattern to the dislocation (direction? dislocating movement?) or is it in more then one direction? If it is directional thinking of an immobilisation that prevents that direction may be helpful. I think you really have to come up with something that immobilises the shoulder so he can move his body freely without the shoulder dislocating.

I would think a Bobath sling would not give enough support. Possibly you could try to taping his shoulder at the beginning of the session with the aim of compressing the head against the glenoid fossa. and prevents gliding n the direction(s) it dislocates in. if it is dislocating inferiorly then taping or a sling that stops inferior subluxation may be worth investigating.


I know you are not treating his shoulder but FES to the total rotator cuff at the same time might to build up some strength may help matters. He was obviously relying very heavily on his rotator cuff prior to the stroke to keep the shoulder intact.

Other then that I don't know what to suggest.

Thankyou for the suggestion. I saw the patient this morning and tried taping with the use of his sling to support the humeral head, and it worked very well. In fact, during the entire session, once the taping had been applied, his shoulder did not dislocate or sublux. He was even able to move 30degrees of flexion (when challenging balance). Im going to keep up with this method of supporting the shoulder during treatment and try some more high level balance work with him next session on a gym ball.

Now i'll be able to continue treatment until his orthopaedic review next month so thanks:D

Hey Kate

Well done! Isn't it good when you can find a simple solution to such a difficult probelm