The subluxed shoulder is a common problem post stroke and often treated only with a sling, that really does not offer much support. I think we need to change the way we treat the subluxed shoulder. Historically, weight bearing through the paretic arm has mostly resulted in a painful shoulder. Often the paretic hand is bound / tied to the handle bar of machine that does reciprocal pedaling/rowing/etc. This is really not good for the subluxed shoulder. Every revolution of the handle bar is essentially pulling the arm out of the shoulder joint again.
In my book “Highs, Lows, and Plateaus: a path to recovery from stroke” I talk about the stages of recovery following a stroke. Not everyone goes through these precise stages but it provides a framework. Early on the arm is often flaccid and the shoulder joint becomes subluxed, i.e. the upper arm bone literally slips out of the shoulder socket. A few DO and DO NOT lessons that I have learned:
- Use a sling to keep the arm safe when walking
- Electrical stimulation to the muscles of the shoulder joint is helpful when used daily on a set protocol.
- All exercises for the arm should be done while lying on your back. This provides stability to the shoulder blade and also allows the upper arm to gently glide back into the joint.
- The first exercise is to bring the weak arm gently over head (with help from your strong arm) so that with your hands together, both arms are vertical to the body (90 flexion) and the elbows are straight. Then make TINY little circles with the hands allowing a gentle motion of the shoulder joint. This allows the joint to gently settle into the socket and stimulate the sensory receptors that then excite the muscles around the joint.
- DO NOT Use any type of reciprocal exercise machine for the weak arm!
- DO NOT Put weight through the weak arm – not until the shoulder joint is no longer subluxed out of the socket
- DO NOT Overstretch the arm by having any motion that brings the arm overhead or out to the side. If an overhead motion is made, then the shoulder blade MUST also be rotated to prevent the arm bone from pinching into the front of the shoulder socket
As you do the first exercise the muscles around the shoulder joint will begin to activate again. As the subluxation resolves, the exercises are advanced.