Improving the Prevention of Shoulder Subluxation in Patients with Post-Stroke Hemiparesis

 In the business world just 'improving' a bad situation would be grounds for firing; you're expected to fully fix the problem. That's what you are hired for, to fix things, not just skate by on mediocre work!

Improving the Prevention of Shoulder Subluxation in Patients with Post-Stroke Hemiparesis

• V. KaisinPetro Mohyla Black Sea National University
• D. KhramtsovPetro Mohyla Black Sea National University
• H. KozlovaMC “Expert Health”

DOI:

 https://doi.org/10.12775/JEHS.2026.89.70883

Keywords

stroke, post-stroke hemiparesis, shoulder subluxation, glenohumeral instability, Mulligan Mobilization with Movement/MWM, rehabilitation, upper limb function, acromiohumeral distance, hemiplegic shoulder pain

Abstract

Background: Shoulder subluxation is a common and clinically significant complication of post-stroke hemiparesis, particularly in the early recovery period, when muscle hypotonia and impaired motor control predominate. It is associated with increased risk of hemiplegic shoulder pain and reduced functional recovery, highlighting the need for effective preventive strategies.

Objective: To improve prevention of shoulder subluxation in patients with post-stroke hemiparesis by evaluating the effectiveness of combining supportive interventions with Mulligan Mobilization with Movement (MWM) manual techniques.

Methods: A prospective randomized controlled trial included 43 patients (45–80 years) in the early recovery period (7–90 days post-stroke). Participants were randomly assigned to a control group (n=21), receiving standard rehabilitation, or a main group (n=22), receiving additional MWM techniques. Outcomes were assessed at baseline and after 4–6 weeks using Fugl–Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Visual Analog Scale (VAS), Modified Barthel Index (MBI), and acromiohumeral distance (AHD). Statistical analysis included Mann–Whitney U test and Spearman correlation (p<0.05).

Results: Both groups improved; however, the main group demonstrated significantly greater gains in motor function (FMA-UE: 48 vs 41; p=0.003) and functional activity (ARAT: 38 vs 28; p=0.002), along with greater pain reduction (VAS: 1 vs 2; p=0.01) and improved joint stability (AHD: 9.8 mm vs 11.5 mm; p=0.004). Strong positive correlation was observed between FMA-UE and ARAT (ρ=0.71; p<0.001), while AHD and VAS negatively correlated with functional outcomes.

Conclusions: The addition of Mulligan MWM techniques to standard rehabilitation significantly enhances motor recovery, reduces pain, and improves shoulder stability in post-stroke patients, supporting their inclusion in early rehabilitation protocols.

A Comparative Study to Assess the Effects of Comprehensive Rehabilitation Programme with and without Bobath Sling in Post-stroke Painful Shoulder Subluxation

 

Who still uses NDT(Bobath) in stroke rehab when it should have been shitcanned since 2003? Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003)

A Comparative Study to Assess the Effects of Comprehensive Rehabilitation Programme with and without Bobath Sling in Post-stroke Painful Shoulder Subluxation

Mukherjee, Ushnish¹; Ghosal, Vasundhara¹; Ray, Siddhartha Sinha¹; Mandal, Pankaj Kumar²; Khatua, Dilip Kumar³

Author Information

Indian Journal of Physical Medicine & Rehabilitation 35(3):p 205-211, Sep–Dec 2025. | DOI: 10.4103/ijpmr.ijpmr_24_25

• Open

Abstract

Background: 

Post-stroke painful shoulder subluxation is a common condition in day-to-day Physiatric practice. Rehabilitative strategies along with the use of different shoulder supports showed variable outcomes while managing these patients.

Aims and Objectives: 

To assess the effects of using Bobath shoulder sling in Post-stroke painful shoulder subluxation.

Materials and Methods: 

This comparative study was conducted with patients of post-stroke painful shoulder subluxation after considering the inclusion and exclusion criteria. Participants were randomly divided into two groups (group 1 and 2) and managed with a comprehensive rehabilitation programme. Bobath shoulder sling was given only to the group 1. Intensity of shoulder pain was measured by 0-10 Numerical Rating Scale(NRS). Acromio-Greater Tuberosity Distance difference (AGTDD) was used for gleno-humeral subluxation quantification, and Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was used for assessing sensori-motor recovery. All the variables were measured at the baseline/visit 1, 6^th week/visit 2, 12^th week/visit 3 and 24^th week/visit 4. Total 30 cases (15 in each group) were analysed.

Results: 

Intra-group analysis showed improvement in all parameters during all the follow ups (P < 0.001). During inter group comparison, group1 showed a statistically significant improvement during follow up at 6^th week in terms of pain intensity (P = 0.029), degree of shoulder subluxation (P = 0.036) and sensorimotor recovery (P = 0.023). But, subsequent follow up visits showed no significant difference between the groups (P > 0.05).

Conclusion: 

Use of Bobath shoulder sling was beneficial in early stages of stroke, but it did not provide extra advantage in long term use. However, long term continuation of comprehensive rehabilitation programme was shown to be beneficial.

Does the application of a Lycra arm sleeve change shoulder biomechanics in people with stroke? -- A preliminary study

So you didn't set up the research strong enough to create a protocol, so you punted and asked for more research. WHOM the hell is going to do that? We have NO stroke leadership to initiate followup research.

 Does the application of a Lycra arm sleeve change shoulder biomechanics in people with stroke? -- A preliminary study

JPO: Journal of Prosthetics and Orthotics , Volume 34(2) , Pgs. 116-121.

NARIC Accession Number: J89860.  What's this?
ISSN: 1040-8800.
Author(s): Kumar, Praveen.
Publication Year: 2022.
Number of Pages: 6.
Abstract: Study investigated the effect of Lycra sleeves on the acromion-greater tuberosity (AGT) distance, muscle activity around the shoulder region, and scapular position in six people with stroke. Previous studies found that a Lycra sleeve can reduce AGT distance, used for assessment of glenohumeral subluxation (GHS), in people with chronic stroke. Measurements were taken before and immediately after application of the sleeve. Portable diagnostic ultrasound, electromyography, and a tape measure were used to measure AGT distance, muscle activity (biceps, triceps, deltoid, and supraspinatus), and position of the scapula, respectively. There was a mean reduction of 0.13 centimeters in AGT distance measurements, but this was not statistically significant. The inferior scapula measurements showed a mean reduction of 1 centimeter, and this was statistically significant when compared without and with sleeve application. The application of Lycra arm sleeves did not significantly reduce the AGT distance but altered scapula mechanics by putting it in a mechanically advantaged position in a small sample of people with chronic stroke. These findings suggest that the Lycra sleeve may have potential to alter biomechanics and influence neuromuscular activity in the arm. A properly designed definitive trial would be required to confirm the effectiveness of the Lycra sleeve in reducing GHS in people with both acute and chronic stroke.
Descriptor Terms: BIOENGINEERING, BODY MOVEMENT, JOINTS, LIMBS, MUSCULOSKELETAL DISORDERS, NEUROMUSCULAR DISORDERS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Kumar, Praveen. (2022). Does the application of a Lycra arm sleeve change shoulder biomechanics in people with stroke? -- A preliminary study.  JPO: Journal of Prosthetics and Orthotics , 34(2), Pgs. 116-121. Retrieved 10/25/2022, from REHABDATA database.

Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke

See if your therapist is following this and using this information for your shoulder. Note the weasel words, can lead and likely. This means that another study will be needed to actually prove something.
You'll have to ask your therapist for what this looks like.
http://www.jneuroengrehab.com/content/10/1/88/abstract

Abstract (provisional)

Background

Shoulder subluxation is a frequent complication of motor impairment after stroke, leading to soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain, thus limiting use of the affected extremity beyond weakness. In this pilot study, we determined whether robotic treatment of chronic shoulder subluxation can lead to functional improvement and whether any improvement was robust.

Methods

18 patients with chronic stroke (3.9+/-2.9 years from acute stroke), completed 6 weeks of robotic training using the linear shoulder robot. Training was performed 3 times per week on alternate days. Each session consisted of 3 sets of 320 repetitions of the affected arm, and the robotic protocol alternated between training vertical arm movements, shoulder flexion and extension, in an anti-gravity plane, and training horizontal arm movements, scapular protraction and retraction, in a gravity eliminated plane.

Results

Training with the linear robot improved shoulder stability, motor power, and resulted in improved functional outcomes that were robust 3 months after training.

Conclusion

In this uncontrolled pilot study, the robotic protocol effectively treated shoulder subluxation in chronic stroke patients. Treatment of subluxation can lead to improved functional use of the affected arm, likely by increasing motor power in the trained muscles.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

SMARTPATCH May Soon Reduce Post Stroke Shoulder Pain

I had shoulder pain for a couple of weeks and the only direction I got was to rest it. Which led to the start of subluxation.
http://www.medgadget.com/2011/04/smartpatch_may_soon_reduce_post_stroke_shoulder_pain.html
MedCity News is reporting that SPR Therapeutics of Cleveland, Ohio is close to receiving FDA regulatory approval for its SMARTPATCH Peripheral Nerve Stimulation System aimed at treating shoulder pain in patients post stroke. The device utilizes percutaneous leads to stimulate muscle activity and in turn reduce pain.

More at link.

Glenohumeral subluxation in hemiplegia: An overview

In case this is one of your problems, they do talk a bit about shoulder pain which was one of my problems although my shoulder never subluxed.
This has nothing to do with chiropractic subluxation.
http://www.rehab.research.va.gov/jour/05/42/4/pdf/paci.pdf
The shoulder complex consists of four separate joints,
which afford it incredible mobility in all planes of motion,
but at the expense of its stability. The glenohumeral joint
(GHJ) relies on the integrity of muscular and capsuloligamentous
structures rather than bony conformation for its
stability [1]. Injury or paralysis of muscles around the
shoulder complex may lead to GHJ subluxation. Glenohumeral
subluxation (GHS), a frequent complication for
patients with a poststroke hemiplegia, is reported to be
present in 17 to 81 percent of patients with hemiplegia
following stroke [2], However, GHS’s role in poststroke
complications is still controversial. Although the impact
of GHS on the development of shoulder pain (SP) and
upper-limb functional recovery has not been completely
explained, a number of authors [2–6] consider GHS an
important source of SP. Moreover, several recent reviews
focused on SP describe GHS management as the main
intervention to prevent SP [2,5–6]. Thus, although GHS is
probably the most cited problem causing shoulder complications
after stroke, no paper is available that focuses
directly on this problem and describes in detail the main
aspects of the origin, assessment, or treatment of this frequent
and poorly understood complication.
This paper intends to—
• provide an extensive overview on GHS,
• help explain its role in poststroke complications,
• report the reliability and validity of clinical evaluations,
and
• summarize the effectiveness studies on its prevention
and management.

Rest at the link.