Electrophysiological investigation on shoulder subluxation in hemiplegics

Twenty-one consecutive hemiplegic patients underwent electrophysiological evaluation of their shoulder subluxation. The patients comprised 13 men amd 8 women, with a mean age of 57 years. The distal latency times of the suprascapular, axillary, musculocutaneous and radial nerves were 4.8, 6.2, 5.3 and 5.5 msec, respectively, and all nerves tested were statistically delayed. Ten out of 21 suprascapular nerves did not respond adequately. Based on needle EMG studies, about 75% of the supraspinatus and deltoid muscles revealed increased insertional activity and/or positive sharp waves. It is postulated that shoulder subluxation in hemiplegics may be caused by brachial plexus lesions. As regards therapeutic measures, the paralysed flaccid shoulder should be placed in a retracted posture or suspended to prevent the joint from being overstretched and ROM exercise of the shoulder joint should be carried out as a cautious maneuver to avoid displacement of the glenohumeral joint.