Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects: A Case Series.

Abstract

Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.