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Hemiplegic Shoulder Subluxation Rehabilitation

Inferior glenohumeral subluxation that develops in 80% of stroke patients requires multimodal positioning, FES, taping, and orthosis treatment.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Fizik Tedavi ve Rehabilitasyon department. Book Appointment →

What is Hemiplegic Shoulder Subluxation Rehabilitation?

Hemiplegic shoulder subluxation is a complication that develops in 50-80% of stroke patients in the first weeks. Inferior displacement (>1 finger breadth gap on radiograph) develops due to weakness of the supportive musculature (deltoid, supraspinatus, infraspinatus) and dysfunction of the biceps long head and gravity.

Pathomechanism: in flaccid hemiplegia, the superior angle of the scapula is fixed, but with rotator cuff weakness, the humeral head shifts inferiorly. With increasing spasticity, internal rotation contracture and adhesive capsulitis (frozen shoulder) develop. Complications: brachial plexus traction injury, CRPS Type 1, chronic shoulder pain, sleep disturbance.

Multimodal management: positioning (lying — supported on pillow, sitting — armrest), slings/orthoses (Bobath sling, GivMohr, Cascade — controversial), taping (kinesio tape RCT evidence), functional electrical stimulation (FES — supraspinatus + posterior deltoid, gold standard, evidence-based), passive ROM exercises (3x/day), strengthening (when active movement returns). Pain management: NSAIDs, intra-articular steroid, suprascapular nerve block, botulinum if spasticity.

Symptoms

Visible step at the shoulder (acromion-humeral head)
Palpable inferior gap (Fingerbreadth measurement)
Shoulder pain at rest and during movement
Limited range of motion (especially abduction, external rotation)
Brachial plexus traction symptoms (numbness, weakness)
CRPS findings (color, temperature, edema)

Risk Factors

Flaccid hemiplegia (early period)
Spastic hemiplegia (chronic phase)
Inadequate positioning (poor support)
Pulling on the affected arm during transfer
Untreated rotator cuff dysfunction
Cognitive impairment

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Early stroke phase (in first month)
  • Increasing shoulder pain
  • Limitation of range of motion
  • CRPS findings (urgent)
  • Brachial plexus symptoms
  • Limitation of daily living activities

Treatment Methods

01
Positioning education (lying, sitting, transfer)
02
Functional electrical stimulation (FES, evidence-based)
03
Taping (kinesio tape, RCT supported)
04
Sling/orthosis (Bobath, GivMohr — selectively)
05
Passive + active ROM exercises (3x/day)
06
Suprascapular nerve block (refractory pain)

Which Department to Visit?

You can visit our Fizik Tedavi ve Rehabilitasyon department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Fizik Tedavi ve Rehabilitasyon Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.