Malalignment of the shoulder after stroke

One hundred and ten consecutive patients (51 men, 59 women) admitted to a stroke unit were studied for radiographic changes at the shoulder on the affected side. Malalignment was found in 51 (46%) patients, of whom 37 (72.5%) had changes on the initial x-ray film and a further 14 (27.5) developed malalignment over the following 12 months. These findings indicate that malalignment of the shoulder is common in the early stages of a stroke and may be missed unless radiographs are taken with the patient erect and the arm unsupported. Malalignment may lead to delay and limitation in restoration of function. The consequences of malalignment can be prevented by correct handling, positioning, and full passive movement of the shoulder from the onset of the stroke.