Shoulder Subluxation Research Articles

A protocol-based treatment plan to improve shoulder function in children with brachial plexus birth injury: a comparative study.

Children with permanent brachial plexus birth injury have a high risk of developing posterior shoulder subluxation. In 2010, we implemented a protocol to reduce the incidence of this deformity, including early passive exercises, ultrasound screening, botulinum toxin-A injections, shoulder splinting and targeted surgeries. Two-hundred and thirty-seven consecutive children treated at our institution, with a mean follow-up of 11 years (range 1 to 17) were compared in three groups: children born from 1995 to 1999 (n = 53), 2000-2009 (n = 109) and 2010-2019 (n = 75). Posterior shoulder subluxation developed in 48% of all patients but the mean age at detection of shoulder subluxation decreased from 5 years to 4.9months. Need for shoulder relocation surgery also decreased from 28% to 7%. Mean active shoulder external rotation in adduction improved from 2° to 46°. In conclusion, our established protocol has the potential to reduce the incidence of posterior shoulder subluxation in children with brachial plexus birth injury.Level of evidence: II.

Effects of position-triggered electrical stimulation on poststroke hemiparetic shoulder subluxation.

Shoulder subluxation is a frequent complication after stroke causing joint instability, shoulder pain, decreased activities of daily living, and impedance to rehabilitation progress. Electrical stimulation (ES) is considered an effective modality to reduce shoulder subluxation in acute stroke. However, few studies have investigated the effect of position-triggered ES, which induces active muscle contraction though accurate motion detection. The aim of this study was to investigate whether position-triggered ES was more effective in reducing acute hemiplegic shoulder subluxation after stroke than passive ES. Single-blind, randomized controlled trial. The study setting was the university hospital rehabilitation center. Fifty poststroke subacute hemiparetic patients with shoulder subluxation. Patients were randomly assigned into two groups. The position-triggered ES group received 30-minute ES sessions, 5 days per week for 3 weeks with specially modified Novastim® CU-FS1 (CU Medical Systems, Inc., Gangwon-do, South Korea) for motion triggering. The passive ES group received the same protocol without motion triggering. The vertical distance (VD) and the joint distance (JD), relative VD and JD (rVD, rJD), upper extremity component of Fugl-Meyer Motor Assessment (FMA<inf>upper</inf>), Motricity Index (MI), Manual Function Test (MFT), and peak torque of affected shoulder abductor (PT) were assessed at baseline (T0), end of electrical stimulation session (T1), and 3 weeks (T2) after treatment. Repeated-measures analysis of variance revealed significant interaction between time and intervention on JD and rJD, indicating that shoulder subluxation was significantly more reduced in position-triggered ES than in passive ES (P<0.05). However, FMA<inf>upper</inf>, MI, MFT, and PT did not show this significance. The change of (∆)JD, ∆rVD, and ∆rJD in the motion-triggered ES group improved significantly more at T1 than in the passive ES group (P<0.05). This significant improvement was not seen at T2. Position-triggered ES may be more effective than passive ES in improving poststroke shoulder subluxation; however, this effect was not maintained after the withdrawal of stimulation. Position-triggered ES may be useful to reducing poststroke shoulder subluxation.

O09 Recurring brachial plexopathy- the zebra among the horses

O09 Recurring brachial plexopathy- the zebra among the horses

The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

Background:Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures.Purpose:To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts.Study Design:Case series; Level of evidence, 4.Methods:Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed.Results:The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts’ shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation.Conclusion:The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report

The Effects of Comprehensive Occupational Therapy for Hemiplegic Upper-extremity both with Rotator Cuff Calcific Tendinopathy and Shoulder Subluxation：A Case Report

Indications for amputation after traumatic brachial plexus injury in adults: Case report and review of new prosthetic technologies

Hand amputation can be discussed after traumatic brachial plexus injury when the patient’s hand is non-functional, painful and/or insensitive. That indication is more common in English-speaking countries than in European or Latin countries. New prostheses are now on the market and can be used after hand amputation to improve the functional prognosis in well-selected patients. A 26-year-old male was involved in a road accident in January 2016. He had a traumatic brachial plexus injury and underwent nerve surgery to restore the biceps brachii and triceps brachii. One year after nerve transfer, his hand was insensitive and non- functional. After multidisciplinary consultation, it was decided to amputate his hand to replace it with a myoelectric prosthesis. Shoulder subluxation pain and complications associated with an insensitive and heavy arm were improved after hand amputation. Functional outcomes were improved with this revolutionary myoelectric prosthesis technique. The patient was able to use his prosthesis for many daily activities. Selective amputation indications after traumatic brachial plexus injury are a heavy and stiff arm with shoulder subluxation pain and an unusable claw hand. The patient’s motivation must be high.

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

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.

Subluxed Shoulders Need TLC: Pilot Study of the T-L-C Taping Method to Address Hemiplegic Shoulder Pain, Passive Range of Motion, and Subluxation

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Hemiplegic shoulder pain and subluxation are prevalent sequelae following stroke. A gap in the literature exists for shoulder assessments specifically for taping, a common intervention. Studies and tape methods primarily focus on mechanical corrections. However, muscle tone and management, which are prevalent topics in neurological rehabilitation, are rarely addressed. The T-L-C taping method consists of a uniform assessment approach of the shoulder specifically to guide Kinesio® Tape application Primary Author and Speaker: Steven Frey Additional Authors and Speakers: Mark Stumpf, Jacob Wright, and Sara Stephenson Contributing Authors: John Wong, Lauren Loges

Effects of Elastic Taping Application Added on Conventional Rehabilitation Therapy to Improve Shoulder Pain and Upper Extremity Motor Function on Subacute Phase Stroke Patients with Shoulder Subluxation

ABSTRACTIntroduction: To determine the effect of adding elastic taping to conventional rehabilitation therapy on the improvement of shoulder pain and motor function of the upper limbs in patients with subacute strokewith shoulder subluxation.Methods: Research subjects who met the inclusion criteria were recruited from medical rehabilitation clinic in RSUD Dr, Soetomo. The total research subjects were 20 people (10 in treatment group and 10 incontrol group). The parameters were Visual Analoque Scale (VAS) for assessing shoulder pain and Fugl Meyer Assessment (FMA) for assessing motor function in the upper limbs.Results: There were significant differences before and after therapy for 3 weeks for VAS (p value = 0.00) in the treatment and control groups, there were significant differences in FMA in the treatment group (p value = 0.04), there were no significant difference in FMA in the control group (p value = 0.06). There was no significant difference in changes of VAS (p value = 0.23) and FMA (p value = 0.32) between the treatment and control groups before and after therapy for 3 weeks.Conclusion: The treatment group and the control group gave the same results on improvement of shoulder pain and motor function of the upper limbs before and after therapy for 3 weeks. There was an improvement in motor function of the upper limbs in the treatment group and there was no improvement in motor function of the upper limbs in the control group befor e and after therapy for 3 weeks.Keywords: conventional rehabilitation therapy, elastic taping, Fugl Meyer Assessment (FMA), Glenohumeral subluxation (GHS), Hemiplegic shoulder pain (HSP), Visual Analoque Scale (VAS).

Effects of Elastic Taping Application Added on Conventional Rehabilitation Therapy to Improve Shoulder Pain and Upper Extremity Motor Function on Subacute Phase Stroke Patients with Shoulder Subluxation

ABSTRACTIntroduction: To determine the effect of adding elastic taping to conventional rehabilitation therapy onthe improvement of shoulder pain and motor function of the upper limbs in patients with subacute strokewith shoulder subluxation.Methods: Research subjects who met the inclusion criteria were recruited from medical rehabilitationclinic in RSUD Dr, Soetomo. The total research subjects were 20 people (10 in treatment group and 10 incontrol group). The parameters were Visual Analoque Scale (VAS) for assessing shoulder pain and FuglMeyer Assessment (FMA) for assessing motor function in the upper limb s.Results: There were significant differences before and after therapy for 3 weeks for VAS (p value = 0.00)in the treatment and control groups, there were significant differences in FMA in the treatment group (pvalue = 0.04), there were no significant difference in FMA in the control group (p value = 0.06). Therewas no significant difference in changes of VAS (p value = 0.23) and FMA (p value = 0.32) between thetreatment and control groups before and after therapy for 3 wee ks.Conclusion: The treatment group and the control group gave the same results on improvement ofshoulder pain and motor function of the upper limbs before and after therapy for 3 weeks. There was animprovement in motor function of the upper limbs in the treatment group and there was no improvementin motor function of the upper limbs in the control group befor e and after therapy for 3 weeks.Keywords: conventional rehabilitation therapy, elastic taping, Fugl Meyer Assessment (FMA),Glenohumeral subluxation (GHS), Hemiplegic shoulder pain (HSP), Visual Analoque Scale (VAS).

PENGARUH PEMBERIAN FUNCTIONAL ELECTRICAL STIMULATION (FES) TERHADAP SKALA NYERI SUBLUKSASI SHOULDER PADA PASIEN POST STROKE DI RUMAH SAKIT GRANDMED LUBUK PAKAM

Science and technology today become an inseparable part of the technology of modern society's life. Functional Electrical Stimulation (FES) to support recovery of upper limb after stroke. This research is a quantitative research with a quasi-experimental / quasi-experimental approach to the research design using pre-test and post-test. Determination of the number of samples using the Purposive Sampling method and get a sample of 12 people. Data collection was carried out by direct interview using observation sheets. The independent variable in this study is Functional Electrical Stimulation (FES) while the dependent variable is the Shoulder Subluxation Pain Scale. The assessment of shoulder subluxation pain scale includes a mild pain scale category of 6 people (50%), and moderate pain 4 people (33.3%) and very severe pain 2 people (16.7). Statistical test using Paired Sample T-test with α = 0.05. The results of the analysis show that there is a significant influence between the provision of Functional Electrical Stimulation (FES) on the scale of shoulder pain subluxation in post-stroke patients, ie with a p value (0.001≤0.05). The conclusion of this study is that there is an influence between Functional Electrical Stimulation (FES) with Shoulder Subluxation Pain. Advice can be given is expected for post stroke patients and family support to pay attention to the patient's monotonous sleeping position.

A New Shoulder Orthosis to Dynamically Support Glenohumeral Subluxation.

In this paper we presented a novel shoulder subluxation support that aims to reduce the stress on the passive structures around the shoulder of patients with glenohumeral subluxation and glenohumeral-related shoulder pain. The device applies a force to the upper arm without impeding the functional range of motion of the arm. Our design contains a mechanism that statically balances the arm with two elastic bands. A technical evaluation study was conducted to assess the performance of the orthosis. Additionally, two patients evaluated the orthosis. The results of the technical validation confirm the working of the balancing mechanism. The pilot study demonstrated that the shoulder support increased the feeling of stability of the shoulder joint and, to a lesser extent, decreased shoulder pain. Furthermore, both patients reported that the orthosis did not impede their range of motion. In this research we developed a shoulder orthosis based on two statically balanced springs that support the shoulder of patients with glenohumeral subluxation that have residual shoulder muscle force. Compared to existing shoulder supports, our design does not impede the range of motion of the arm, and continues to provide a stabilizing force to the shoulder, even if the arm is moved away from the neutral position. Tests with two participants showed promising results. The device presented in this work could have a significant impact on the shoulder function which may improve rehabilitation outcome and improve the quality of life of patients suffering from glenohumeral subluxation and shoulder pain.

Socioeconomic and Demographic Disparities in Early Surgical Stabilization Following Emergency Department Presentation for Shoulder Instability

PurposeTo describe which patients are the most likely to undergo surgical management within the same calendar year as their emergency department visit for anterior shoulder instability.MethodsThe State Emergency Department Databases and State Ambulatory Surgery and Services Databases from Florida were used. All patients presenting to the emergency department for anterior shoulder subluxation or dislocation between January 1 and September 30, 2017, were selected. Bivariate analysis was performed for associations with demographic variables. A binary logistic regression was performed with all significant factors to assess which were predictors of undergoing surgery the same calendar year.ResultsWhile controlling for all significant factors, we found that patients with recurrent dislocations were 3.14 times more likely to have surgery within the same year (P = .037). Patients younger than 40 years were also 2.04 times more likely to have surgery than those aged 40 years or older (P < .001). White patients were 2.47 times more likely to have surgery than black patients (P < .001). On bivariate analysis, there was an association between greater income quartile and higher odds of undergoing surgery within 30 days.ConclusionsFollowing an emergency department visit for acute shoulder instability, the following variables were associated with undergoing surgical stabilization within the same calendar year: previous dislocation, age younger than 40, and white race. Patients living in the greatest income quartile of patients had a significantly greater percentage of patients having surgery within 30 days. This demonstrates that disparities and barriers to care may exist for patients with shoulder instability.Level of EvidenceLevel III, Retrospective Comparative Study.

Effects of mirror therapy vs modified constraint induced movement therapy on upper extremity in subacute stroke patients

Objective: To compare and to examine the effectiveness of mirror therapy and modified constraint induced movement therapy (mCIMT) on upper extremity in subacute stroke patients.&#x0D; Background: Stroke or cerebral vascular accident is sudden dead of the brain cells due to inadequate blood flow. The WHO defines stroke as rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting for 24hrs or longer or leading to death, with no apparent cause other than of vascular origin. The most common consequence of stroke is loss of upper limb function. The protocol planned for improving the function of upper limb are mirror therapy and modified constraint induced movement therapy (mCIMT). Mirror therapy is a simple and inexpensive treatment which uses the visual information activating the premotor and motor cortex of the brain. This is explained by activation of so called mirrorneuron system. Whereas mCIMT utilises the redundant pathway in brain through neuro plasticity.&#x0D; Methodology: A total of 30 participants with subacute stroke were selected. The inclusion criteria are both gender of age 55-70 years and duration of 2-12 months of post stroke. Participants with mini mental state examination score&lt;24, uncontrolled systemic hypertension, severe shoulder subluxation, previous stroke and severe cardiac failure were excluded. The outcome measures were measured using Upper Extremity Functional Index (UEFI) and Fugl Meyer Upper Extremity Scale.&#x0D; Procedure: All 30 participants with sub-acute stroke were divided into two groups. Both the group individuals were assessed for pre test using Fugl Meyer Upper Extremity Scale and Upper Extremity Functional Index Scale. Group A (15) was assigned to mirror therapy for 5 days a week, for 4 weeks and rest intervals was given. Similarly group B (15) was assigned to modified constraint induced movement therapy for 5 days a week, for 4 weeks. Both the groups were given conventional therapy for 20 mins. At the end of study subjects were assessed for post test using UEFI and Fugl Meyer upper extremity scale.&#x0D; Results: The Modified Constraint Induced Movement (mCIMT) is more effective than Mirror Therapy in improving the hemiparetic upper extremity in subacute stroke patients.&#x0D; Bangladesh Journal of Medical Science Vol.20(2) 2021 p.323-329

Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study

ABSTRACT Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients. Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function. Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05). Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function.

Subluxed Shoulders Need “TLC”: A Pilot Study of T-L-C Elastic Taping to Address Hemiplegic Shoulder Pain, Passive Range of Motion, and Sub-luxation

Shoulder subluxation, abnormal tone, and hemiplegic shoulder pain are common sequelae for patients with neurological conditions. Therapists have used elastic taping to treat these consequential conditions in rehabilitation settings with inconsistent techniques and results. The use of elastic tape to treat shoulder subluxation, abnormal tone, and hemiplegic shoulder pain may result in increased participation in activities of daily living and functional activities; however, evidence-based approaches to guide taping are still emerging. An elastic taping method called the "T-L-C" method has been developed to establish a consistent approach for the assessment and taping to ensure patients are being treated with evidence-based techniques.

Neuro Developmental Techniques with Functional Electrical Stimulation reduces shoulder dysfunction in young stroke population : A quasi-experimental novel rehabilitative approach

Stroke is the third-largest common cause of death and is the leading cause of adult impairment. Shoulder subluxation is a common complication after a stroke and has always been a challenge, making the motor and functional recovery more complicated. Sixty-nine per cent of people affect with an arm in stroke, and the critical aim of stroke therapy is to recover their arm function. Motor impairments such as flaccidity and spasticity may make a patient functionally dependent on another person for their ADL, particularly in the upper extremity for a long time. Also, these motor impairments can address other problems such as subluxation of the shoulder and pain. To evaluate the effect of NDT along with FES in the management of shoulder dysfunction following stroke. A quasi-experimental study involved 70 consecutive subjects age (30-60 years) affected by stroke recruited in the study. They are divided into two groups Group A (experimental group, N=35) and Group B (control group, N=35). Group A received NDT along with FES, and Group B received NDT treatment. Treatment was given five days a week for six weeks. The analysis of the study showed a statistically significant difference in shoulder pain, and subluxation in the experimental group (Group A) compared to the control group (Group A). FES is effective in reducing shoulder pain and subluxation early after stroke. Hence NDT along with FES is more effective than NDT alone.

Radial nerve palsy following uncomplicated percutaneous nephrolithotomy

Injury to nerve is a well known complication of shoulder subluxation. Radial nerve injury is most commonly seen during percutaneous nephrolithotomy in lateral decubitus region. If the posterior aspect of the humerus is positioned incorrectly leads to radial nerve compression. Lateral decubitus position in percutaneous nephrolithotomy is the main position for posterior and lateral approaches. After percutaneous nephrolithotomy in lateral decubitus position reported the case of radial nerve palsy. A man of 26 year old from left (contralateral) percutaneous nephrolithotomy with signs of right radial nerve palsy on postoperative day number one. The body mass index is 28 &amp; underwent laterally attempted percutaneous nephrolithotomy on the left and he was located about 6 h and 30 min in the lateral decubitus position. Orthopedics, physiotherapy and electromyography were done to treat radial nerve palsy in the post-operative period. It demonstrates complication of the radial nerve palsy which may be related with percutaneous nephrolithotomy. Being aware of the complication can be used to stop pressure points at percutaneous nephrolithotomy in the lateral decubitus position.

Incidence of Posterior Shoulder Instability in the United States Military: Demographic Considerations From a High-Risk Population

Background: Relatively little is known about the true incidence of posterior shoulder instability in the United States. Purpose/Hypothesis: The purpose of this study was to characterize the incidence of posterior shoulder instability in the US military population and to examine which characteristics place these patients at highest risk. We hypothesized that the rate of posterior instability in this cohort of patients would be higher than previously reported. Study Design: Descriptive epidemiology study. Methods: All initial cases of posterior shoulder dislocation and subluxation in the Defense Medical Epidemiology Database were screened between 2016 and 2018 using the relevant International Classification of Diseases–Tenth Revision-Clinical Modification codes. Incidences were calculated, and multivariate Poisson regression was used to calculate adjusted rate ratios for the effects of sex, race, age, military service branch, rank, and year. Results: The overall unadjusted incidence was 0.032 per 1000 person-years for posterior dislocations, 0.064 per 1000 person-years for posterior subluxations, and 0.096 per 1000 person-years for all cases of posterior shoulder instability. The total incidence of all shoulder instability was 1.84 per 1000 person-years, with posterior shoulder instability accounting for 5.2% of total cases. For posterior subluxation, significant differences between groups were found in the unadjusted and adjusted rate ratio (ARR) for sex (ARR, 3.31; 95% CI, 1.85-5.93 for men), race (ARR, 0.458; 95% CI, 0.294-0.714 for Black servicemembers and ARR, 0.632; 95% CI, 0.421-0.948 for servicemembers of other race), age (ARR, 3.69; 95% CI, 1.56-8.70 for patients aged 30-34 years), and military service branch (ARR, 0.663; 95% CI, 0.460-0.955 for Air Force servicemembers). For posterior shoulder dislocations, a significant difference was found only between men and women (ARR, 4.55; 95% CI, 1.85-11.2 for men). Conclusion: The incidence of posterior shoulder instability among US military personnel is higher than previously reported in the general US population, with a majority of cases due to subluxation. This increased incidence is likely reflective of a young and highly active population along with improvements in awareness and diagnosis of posterior instability in recent years.

A comparative study to assess the satisfaction with clinical outcome of the patients suffering from hemiplegic shoulder subluxation and undergoing rehabilitation with and without Bobath shoulder sling

Background: Hemiplegic shoulder subluxation is one of the most common factor for post-stroke upper limb disability. There are various ways to assess its outcome during rehabilitation, but the assessment of patients’ satisfaction with the shoulder support is often missed. This study was done to compare those patients’ satisfaction with clinical outcome who were undergoing same rehabilitation programme for their hemiplegic shoulder subluxation with and without Bobath shoulder sling.Methods: This prospective controlled interventional study was conducted on 30 patients of both sexes within the age group of 45-65 years with hemiplegic (duration &lt;6 weeks) gleno-humeral subluxation (GHS). Screening of GHS was done by palpation. They were randomly divided in two groups of same number (15 in each group) and put on rehabilitation protocol with group 1 receiving Bobath shoulder Sling as support for subluxed shoulder and group 2 continuing without it. Patients’ satisfaction on clinical outcome was measured with clinical global impression-improvement (CGI-I) scale. Data were collected at 6 weeks (first follow up-visit), 12 weeks (visit 2) and at the end of the study i.e. 24 weeks (visit 3).Results: Statistically significant difference (p=0.003) in mean score of CGI-I at visit 1 suggested significant improvement for group 1 but no statistically significant difference in improvement was noticed between the groups at visit 2 (p=1.000) and visit 3 (p=0.724).Conclusions: Use of support for hemiplegic shoulder is beneficial only during early days of rehabilitation, not on prolonged use.