Risk factors for inferior shoulder subluxation in patients with stroke

Abstract

Objective: Shoulder subluxation is reported in up to 81% of stroke patients. It presents considerable challenges to those involved in rehabilitation. Extensive research has focused on treatment strategies used to reduce subluxation. A better understanding of the risk factors of shoulder subluxation would enable clinicians to provide effective management of this debilitating complication. Methods: A systematic online search was conducted of MEDLINE, EMBASE, CINAHL, AMED and PEDro databases using appropriate keywords. The search was supplemented by citation tracking from the retrieved papers and manual searches of relevant journals. The search was limited to articles in the English language. All primary studies fulfilling the review's inclusion criteria were included. Four reviewers extracted the data and independently appraised the methodological quality of the selected studies. Discrepancies were resolved following discussions. Results: Of the 36 abstracts identified, eight articles met the inclusion criteria. Complete loss of motor function/severity of arm paralysis, apparent absence of supraspinatus contraction, sensory impairment, loss of proprioception and hemorrhagic type of stroke were identified as potential risk factors. Downward tilting of scapula did not emerge as a risk factor as previously suggested. Conclusion: Despite methodological flaws such as small sample size and the use of insensitive outcome measures, complete loss of motor function in the affected arm has been recognized as a significant risk factor for post-stroke subluxation. The best way to prevent subluxation is to encourage task-specific functional activities to increase voluntary motor control around the shoulder and to advise strengthening exercises to re-establish strength of rotator cuff muscles.