Shoulder subluxation after stroke: A comparison of four supports

Objective: Shoulder subluxation is a well-known sequela of stroke. This study quantitatively compares the reduction of shoulder subluxation using four supports: the single-strap hemisling, the Bobath roll, the Rolyan humeral cuff sling, and the Cavalier support. Design/Setting: Anteroposterior shoulder radiographs of 20 consecutive first-time stroke survivors in a freestanding rehabilitation hospital were taken within 6 weeks of stroke onset. Vertical, horizontal, and total asymmetries of glenohumeral subluxation compared with the unaffected shoulders were measured before and after fitting of each support. Main Outcome Measures: Group means were compared to find which supports altered subluxation asymmetries and approximated the unaffected shoulder. Individual data were tallied to detect how often each support best reduced subluxation asymmetries. Results: The single-strap hemisling eliminated the vertical asymmetry of subluxation over the entire study group, but each support corrected the vertical asymmetry best in some subjects (55%, 20%, 40%, and 5%, respectively). The Bobath roll and the Cavalier support produced lateral displacements of the humeral head of the affected shoulder ( p = 0.005, 0.004, respectively). The Rolyan humeral cuff sling significantly reduced total subluxation asymmetry ( p = 0.008), whereas the single-strap hemisling, Bobath roll, and Cavalier support did not alter total asymmetry ( p = 0.091, 0.283, 0.502, respectively). Conclusion: When treating shoulder subluxation, several different types of supports should be evaluated to optimize the function of the affected extremity and the reduction of the shoulder subluxation.