Management of the hemiplegic shoulder complex

Area of Science:

• Neurology
• Physical Therapy
• Rehabilitation Medicine

Background:

• Hemiplegia, particularly affecting the upper limb and shoulder complex, is a frequent consequence of cerebrovascular events.
• Effective, evidence-based interventions are crucial for managing this common secondary impairment.

Purpose of the Study:

• To outline key considerations for the assessment and treatment of the hemiplegic shoulder.
• To review the efficacy of various interventions for shoulder subluxation and pain in hemiplegia.

Main Methods:

• Assessment of pelvic and trunk biomechanical alignment is a prerequisite for addressing shoulder movement.
• Guidelines for safe passive range of motion (PROM) for the hemiplegic shoulder are detailed, emphasizing limits to prevent further injury.
• Evidence regarding the use of slings, surface neuromuscular electrical stimulation (sNMES), and taping/strapping for subluxation and pain is reviewed.

Main Results:

• PROM requires extreme caution, not exceeding 90° of flexion/abduction without proper scapular and humeral rotation.
• The use of slings for upper limb hemiplegia should be limited.
• sNMES demonstrated effectiveness for shoulder subluxation when applied following a specific protocol (6 hours/day, 5 days/week for 6 weeks).
• Taping/strapping showed conflicting evidence for pain reduction and did not improve function or range of motion in subluxation.

Conclusions:

• Proper biomechanical assessment and cautious PROM are fundamental in managing hemiplegic shoulder impairments.
• Surface neuromuscular electrical stimulation is a recommended intervention for shoulder subluxation in hemiplegia.
• Limited evidence supports the use of slings and taping/strapping for improving outcomes in hemiplegic shoulder conditions.