Abstract

Objective: The purpose of this narrative review is to summarize the recent advances in Glenohumeral subluxation (GHS) treatment approaches. Background: Glenohumeral subluxation (GHS) subluxation is found 81% of the individuals following stroke, a preventable secondary complication often accompanied with poor upper limb function. GHS is also considered as an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon with very little understanding of its pathomechanics. Method: The literature was obtained by searching in computerized database. Evidence was obtained from articles published in peer-reviewed journal and published in English language. Discussion and Conclusion: Ultrasound measurements are considered the best method of quantifying GHS. Clinical evaluation such as finger-breadth method and sulcus sign can be useful and quick clinical assessment tool. Novel methods such as Functional electrical stimulation and tapping method are effective in an acute stage of hemiplegia and arm slings have been shown a negative impact on rehabilitation of GHS, However, it shall be used for a shorter period of time.

Keywords: Stroke rehabilitation · Glenohumeral subluxation · Physical Therapy intervention

References

  1. 1.Laumann U. Kinesiology of the shoulder joint. Shoulder Replace Berlin Springer. 1987;23–31.
  2. 2.Culham E, Peat M. Functional anato- 55 55 Majmaah Journal of Health Sciences ,Vol. 6, Issue 1, March 2018, Rajab - 1439 Physical Therapy intervention in post stroke shoulder subluxation:Anarrative review my of the shoulder complex. J Orthop Sport Phys Ther. 1993;18(1):342–50.
  3. 3.Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athl Train. 2000;35(3):248.
  4. 4.Hugues A, Di Marco J, Janiaud P, Xue Y, Pires J, Khademi H, et al. Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis . Vol. 7, BMJ Open . London : BMJ Publishing Group LTD ; 2017. p. e013348.
  5. 5.AhmadCS,DyrszkaMD,KwonDH.Biomechanics of the Shoulder. In: Shoulder Arthroscopy. Springer; 2014. p. 17–30.
  6. 6.Harryman 2nd DT, Sidles JA, Harris SL, Matsen3rdFA.Theroleoftherotatorinterval capsule in passive motion and stability of the shoulder. JBJS. 1992;74(1):53–66.
  7. 7.LabriolaJE,LeeTQ,DebskiRE,McMahon PJ.Stabilityandinstabilityoftheglenohumeral joint: the role of shoulder muscles. J shoulder Elb Surg. 2005;14(1):S32–8.
  8. 8.Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8
  9. 9.Wuelker N, Korell M, Thren K. Dynamic glenohumeral joint stability. J shoulder Elb Surg. 1998;7(1):43–52
  10. 10.Mottram SL. Dynamic stability of the scapula. Man Ther. 1997;2(3):123–31
  11. 11.Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction. Clin Orthop Relat Res. 1978;135:165–70
  12. 12.Fisher CM. Concerning the mechanism of recovery in stroke hemiphegia. Can J Neurol Sci. 1992;19(1):57–63.
  13. 13.NakayamaH,StigJørgensenH,OttoRaaschou H, Skyhøj Olsen T. Recovery of upper extremity function in stroke patients: The Copenhagen stroke study. Arch Phys Med Rehabil. 2018 Jan 21;75(4):394–8.
  14. 14.Chae J, Mascarenhas D, Yu DT, Kirsteins A,ElovicEP,FlanaganSR,etal.Poststroke Shoulder Pain: Its Relationship to Motor Impairment, Activity Limitation, and QualityofLife.Vol.88,ArchivesofPhysical Medicine and Rehabilitation . United States : Elsevier Inc ; 2007. p. 298–301.
  15. 15.FarberAJ, Castillo R, Clough M, Bahk M, McFarlandEG.Clinicalassessmentofthree commontestsfortraumaticanteriorshoulderinstability.JBJS.2006;88(7):1467–74.
  16. 16.Paci M, Nannetti L, Rinaldi LA. Glenohumeralsubluxationinhemiplegia:Anoverview. J Rehabil Res Dev. 2005;42(4):557.
  17. 17.Gamble GE, Barberan E, Laasch H, Bowsher D, Tyrrell PJ, Jones AKP. Poststroke shoulder pain: a prospective Majmaah Journal of Health Sciences ,Vol. 6, Issue 1, March 2018, Rajab - 1439 56 56 Physical Therapy intervention in post stroke shoulder subluxation:Anarrative review study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke. Eur J pain. 2002;6(6):467–74.
  18. 18.Lindgren I, Jönsson A-C, Norrving B, Lindgren A. Shoulder pain after stroke. Stroke. 2007;38(2):343–8.
  19. 19.Manske RC. Glenohumeral instability. PhysTherTreatcommonOrthopCond1st edn Jaypee, Philadelphia. 2016;104–20.
  20. 20.Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;400:65–76.
  21. 21.Huang Y-C, Liang P-J, Pong Y-P, Leong C-P, Tseng C-H. Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. J Rehabil Med. 2010;42(1):21–6.
  22. 22.Zorowitz RD, Hughes MB, Idank D, Ikai T, Johnston M V. Shoulder pain and subluxation after stroke: correlation or coincidence? Am J Occup Ther. 1996;50(3):194–201.
  23. 23.Boyd EA, Torrance GM. Clinical measures of shoulder subluxation: their reliability. Can J public Heal Rev Can sante publique. 1992;83:S24-8.
  24. 24.Rajaratnam BS, Venketasubramanian N, Kumar P V, Goh JC, Chan Y-H. Predictability of simple clinical tests to identify shoulder pain after stroke. Arch Phys Med Rehabil. 2007;88(8):1016–21.
  25. 25.StolzenbergD,SiuG,CruzE.Currentand futureinterventionsforglenohumeralsubluxationinhemiplegiasecondarytostroke. Top Stroke Rehabil. 2012;19(5):444–56
  26. 26.Gerber C, Ganz R. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. Bone Joint J. 1984;66(4):551–6.
  27. 27.Dawson J, Fitzpatrick R, Carr A. The assessment of shoulder instability. J Bone Jt Surg Br. 1999;81(3):420–6.
  28. 28.Bohannon RW, Andrews AW. Shoulder Subluxation and Pain in Stroke Patients. AmJOccupTher.1990Jun1;44(6):507–9.
  29. 29.Prevost R, Arsenault AB, Dutil E, Drouin G. Shoulder subluxation in hemiplegia: a radiologic correlational study. Arch Phys Med Rehabil. 1987;68(11):782–5.
  30. 30.Hall J, Dudgeon B, Guthrie M. Validity of clinical measures of shoulder subluxation in adults with poststroke hemiplegia. Am J Occup Ther. 1995;49(6):526–33.
  31. 31.Paci M, Nannetti L, Taiti P, Baccini M, Pasquini J, Rinaldi L. Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiother Res Int. 2007;12(2):95–104. 57 57 Majmaah Journal of Health Sciences ,Vol. 6, Issue 1, March 2018, Rajab - 1439 Physical Therapy intervention in post stroke shoulder subluxation:Anarrative review
  32. 32.Pertoldi S, Di Benedetto P. Shoulderhand syndrome after stroke. A complex regional pain syndrome. Eura Medicophys. 2005;41(4):283–92.
  33. 33.Steinbrocker O. The shoulder-hand syndrome: Associated painful homolateral disability of the shoulder and hand with swelling and atrophy of the hand. Am J Med. 1947;3(4):402–7.
  34. 34.Kondo I, Hosokawa K, Soma M, Iwata M, Maltais D. Protocol to prevent shoulderhand syndrome after stroke. Arch Phys Med Rehabil. 2001;82(11):1619–23.
  35. 35.Hartwig M, Gelbrich G, Griewing B. Functional orthosis in shoulder joint subluxation after ischaemic brain stroke to avoid post-hemiplegic shoulder–hand syndrome: a randomized clinical trial. Clin Rehabil. 2012;26(9):807–16.
  36. 36.Ada L, Foongchomcheay A, Canning CG. Supportive devices for preventing and treating subluxation of the shoulder after stroke. Stroke. 2005;36(8):1818–9.
  37. 37.Linn SL, Granat MH, Lees KR. Prevention of shoulder subluxation after stroke with electrical stimulation. Stroke. 1999;30(5):963–8.
  38. 38.ZorowitzRD,IdankD,IkaiT,HughesMB, Johnston M V. Shoulder subluxation after stroke:acomparisonoffoursupports.Arch Phys Med Rehabil. 1995;76(8):763–71.
  39. 39.Hanger HC, Whitewood P, Brown G, Ball MC, Harper J, Cox R, et al. A randomized controlled trial of strapping to prevent post-stroke shoulder pain. Clin Rehabil. 2000;14(4):370–80.
  40. 40.NefT,MiheljM,RienerR.ARMin:arobot for patient-cooperative arm therapy. Med Biol Eng Comput. 2007;45(9):887–900.
  41. 41.Klamroth-Marganska V, Blanco J, Campen K, Curt A, Dietz V, Ettlin T, et al. Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial. Lancet Neurol. 2014;13(2):159–66.
  42. 42.Dohle CI, Rykman A, Chang J, Volpe BT. Pilot study of a robotic protocol to treat shoulder subluxation in patients with chronic stroke. J Neuroeng Rehabil. 2013;10(1):88.
  43. 43.Dijkers MP, Erlandson RF, Kristy K, Geer DM, Nichols A. Patient and staff acceptance of robotic technology in occupational therapy: a pilot study. J Rehabil Res Dev. 1991;28(2):33.
  44. 44.Johnson MJ, Van der Loos HFM, Burgar CG, Shor P, Leifer LJ. Design and evaluation of Driver’s SEAT:Acar steering simulation environment for upper limb stroke therapy. Robotica. 2003;21(1):13–23.
  45. 45.Lum PS, Burgar CG, Shor PC. Evidence forimprovedmuscleactivationpatternsaf- Majmaah Journal of Health Sciences ,Vol. 6, Issue 1, March 2018, Rajab - 1439 58 58 Physical Therapy intervention in post stroke shoulder subluxation:Anarrative review ter retraining of reaching movements with the MIME robotic system in subjects with post-stroke hemiparesis. IEEETrans Neural Syst Rehabil Eng. 2004;12(2):186–94.
  46. 46.Burgar CG, Lum PS, Shor PC, Van der Loos HFM. Development of robots for rehabilitation therapy: The Palo Alto VA/Stanford experience. J Rehabil Res Dev. 2000;37(6):663–74.
  47. 47.Corke PI, Armstrong-Helouvry B. A search for consensus among model parameters reported for the PUMA 560 robot. In: Robotics and Automation, 1994 Proceedings, 1994 IEEE International Conference on. IEEE; 1994. p. 1608–13
  48. 48.LoAC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, et al. Robot-assisted therapy for longterm upper-limb impairment after stroke. N Engl J Med. 2010;362(19):1772–83.
  49. 49.Kwakkel G, Kollen BJ, Krebs HI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair. 2008;22(2):111–21.
  50. 50.VeerbeekJM,Langbroek-AmersfoortAC, van Wegen EEH, Meskers CGM, Kwakkel G. Effects of robot-assisted therapy for the upper limb after stroke: a systematic review and meta-analysis. Neurorehabil Neural Repair. 2017;31(2):107–21
  51. 51.Andersen LT. Shoulder pain in hemiplegia. Am J Occup Ther. 1985;39(1):11–9.
  52. 52.Bernath V. Shoulder supports in patients with hypotonicity following stroke. Cent Clin Eff Clayt Aust Jan. 2001;
  53. 53.Brooke MM, de Lateur BJ, Diana- Rigby GC, Questad KA. Shoulder subluxation in hemiplegia: effects of three different supports. Arch Phys Med Rehabil. 1991;72(8):582–6.
  54. 54.Teasell R, Foley N, Bhogal S, Salter K. Management of post stroke pain. Evid based Rev stroke Rehabil Available http//www ebrsr com/modules/appendix5 pdf (accessed 22 July 2008). 2011;
  55. 55.Monga TN, Kerrigan AJ. Poststroke Pain. Pain Manag Rehabil. 2002;73.
  56. 56.Dieruf K, Poole JL, Gregory C, Rodriguez EJ, Spizman C. Comparative effectiveness of the GivMohr sling in subjects with flaccid upper limbs on subluxation through radiologic analysis. Arch Phys Med Rehabil. 2005;86(12):2324–9.
  57. 57.Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, et al. Interventions for improving upper limb function after stroke. Cochrane database Syst Rev. 2013;11.
  58. 58.Gracies J-M, Marosszeky JE, Renton R, Sandanam J, Gandevia SC, Burke D. 59 59 Majmaah Journal of Health Sciences ,Vol. 6, Issue 1, March 2018, Rajab - 1439 Physical Therapy intervention in post stroke shoulder subluxation:Anarrative review Short-termeffectsofdynamiclycrasplints onupperlimbinhemiplegicpatients.Arch PhysMedRehabil.2000;81(12):1547–55.
  59. 59.Walsh K. Management of shoulder pain in patients with stroke. Postgrad Med J. 2001;77(912):645–9.
  60. 60.Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther. 2004;71(1):36–46.
  61. 61.Morley A, Clarke A, English S, Helliwell S. Management of the subluxed low tone shoulder: review of the evidence. Physiotherapy. 2002;88(4):208–16.
  62. 62.Jaraczewska E, Long C. Kinesio® taping in stroke: improving functional use of the upper extremity in hemiplegia. Top Stroke Rehabil. 2006;13(3):31–42.
  63. 63.Seneviratne C, Then KL, Reimer M, Then KL, Reimer M. Post-stroke shoulder subluxation: a concern for neuroscience nurses. AXONE-DARTMOUTH THEN HALIFAXNovSCOTIA-.2005;27(1):26.
  64. 64.Lee J-H, Baker LL, Johnson RE, Tilson JK. Effectiveness of neuromuscular electrical stimulation for management of shoulder subluxation post-stroke: A systematic review with meta-analysis. Clin Rehabil. 2017;269215517700696.
  65. 65.Arya KN, Pandian S, Vikas, Puri V. Rehabilitation methods for reducing shoulder subluxation in poststroke hemiparesis: a systematic review. Top Stroke Rehabil. 2017;1–14.
  66. 66.Eraifej J, Clark W, France B, Desando S, Moore D. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis. Syst Rev. 2017;6(1):40.
  67. 67.Wattchow KA, McDonnell MN, Hillier SL. Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence. Arch Phys Med Rehabil. 2017;
  68. 68.Chuang L-L, Chen Y-L, Chen C-C, Li Y-C, Wong AM-K, Hsu A-L, et al. Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training onhemiplegicshoulderpainandarmfunction after stroke: a randomized controlled trial.JNeuroengRehabil.2017;14(1):122.
  69. 69.Chae J, Wilson R, Bennett M, Wongsarnpigoon A, Boggs J. Percutaneous Peripheral Nerve Stimulation for the Treatment of Pain in the Rehabilitation Patient. In: Comprehensive Pain Management in the Rehabilitation Patient. Springer; 2017. p. 899–909.
  70. 70.Park D, Yu KJ, Cho JY, Woo SB, Park J, Majmaah Journal of Health Sciences ,Vol. 6, Issue 1, March 2018, Rajab - 1439 60 60 Physical Therapy intervention in post stroke shoulder subluxation:Anarrative review LeeZ,etal.Theeffectivenessof2consecutiveintra-articularpolydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain:ASTROBE-complaint retrospective study.Medicine(Baltimore).2017;96(46).
  71. 71.Lindgren I, Gard G, Brogårdh C. Shoulder pain after stroke–experiences, consequences in daily life and effects of interventions: a qualitative study. Disabil Rehabil. 2017;1–7.
  72. 72.Wilson RD, Bennett ME, Nguyen VQC, Bock WC, O’dell MW, Watanabe TK, et al. Fully Implantable Peripheral Nerve Stimulation for Hemiplegic Shoulder Pain: A Multi-Site Case Series With Two-Year Follow-Up. Neuromodulation Technol Neural Interface. 2017;
  73. 73.Tyson SF, Chissim C. The immediate effect of handling technique on range of movement in the hemiplegic shoulder. Clin Rehabil. 2002;16(2):137–40
  74. 74.Zhu Y, Su B, Li N, Jin H. Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China. Neural Regen Res. 2013;8(25):2389.
  75. 75.Jang YY, Kim TH, Lee BH. Effects of Brain–Computer Interface-controlled Functional Electrical Stimulation Training on Shoulder Subluxation for Patients with Stroke: A Randomized Controlled Trial.OccupTherInt.2016;23(2):175–85.
  76. 76.Buch E, Weber C, Cohen LG, Braun C, Dimyan MA, Ard T, et al. Think to move: a neuromagnetic brain-computer interface (BCI) system for chronic stroke. Stroke. 2008;39(3):910–7.
  77. 77.Birbaumer N, Murguialday AR, Wildgruber M, Cohen LG. Braincomputer-interface (BCI) in paralysis. In: The European Image of God and Man. Brill; 2010. p. 483–92.
  78. 78.Park J, White AR, James MA, Hemsley AG, Johnson P, Chambers J, et al. Acupuncture for subacute stroke rehabilitation: a sham-controlled, subject-and assessor-blind, randomized trial. Arch Intern Med. 2005;165(17):2026–31.
  79. 79.Park J, Hopwood V, White AR, Ernst E. Effectiveness of acupuncture for stroke: a systematic review. J Neurol. 2001;248(7):558–63.
  80. 80.Wong AMK, Su T-Y, Tang F-T, Cheng P-T, Liaw M-Y. Clinical Trial of Electrical Acupuncture on Hemiplegic Stroke Patients1. Am J Phys Med Rehabil. 1999;78(2):117–22.
Majmaah Journal of Health Sciences · eISSN 1658-8223 · Majmaah University · open access