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Shoulder Subluxation After Stroke: Treatment and Rehabilitation Exercises

how to treat shoulder subluxation after stroke (and how to prevent it from getting worse!)

Shoulder subluxation after stroke can be a painful and limiting condition that impairs your arm mobility.

To help you relieve pain and improve mobility, this article will discuss the causes and treatments for shoulder subluxation after stroke.

You’ll see why shoulder subluxation exercises are the key to recovery, especially after stroke. Let’s get started.

Causes of Shoulder Subluxation After Stroke

The shoulder is the most mobile joint in the body, making it particularly susceptible to problems.

Shoulder subluxation happens when the upper arm bone, called the humerus, becomes partially dislocated from the shoulder socket.

This condition starts when the muscles around the shoulder become weak or paralyzed after stroke. Due to gravity pulling down on the arm, the humerus “drops” from the socket because the muscles cannot hold it in place.

If shoulder subluxation is left untreated, the condition could worsen. If you have shoulder subluxation, it’s critical to see a therapist for accurate diagnosis and treatment.

Below, you will find methods commonly used to treat shoulder subluxation after stroke and prevent the condition from worsening.

How to Treat Shoulder Subluxation after Stroke

Classic treatments for shoulder subluxation include surgery, shoulder slings, closed reduction (manipulating the shoulder back into position), and medication.

However, when shoulder subluxation is caused by stroke, the primary treatment will involve rehabilitative exercise. Shoulder braces and medication may also be used to ease the symptoms and/or pain while rehabilitation is in progress.

For shoulder subluxation after stroke, doctors and therapists prefer rehabilitation over surgery because it addresses the root cause of the problem: communication from the brain.

Movement is controlled by the brain, as nerves carry messages from the brain to the muscles, causing movement. Therefore, mobility issues like shoulder subluxation after stroke are best treated by retraining the brain and the body how to communicate effectively

This may involve practicing shoulder subluxation exercises after stroke to reteach the body how to move.

This will help encourage the arm bone, or humerus, to go back into the socket where it should be, while also improving your arm mobility as a whole.

Strengthening Shoulder Subluxation Exercises After Stroke

The goal of shoulder subluxation exercise after stroke is to both retrain the brain how to use the muscles surrounding the shoulder and also strengthen these muscles.

To help strengthen the shoulder muscles after dislocation, see this video from Bob and Brad (“the most famous physical therapists on the internet”).

As always, be sure to check with your therapist before beginning any exercises to make sure that they’re safe for you!

Some tips from Bob and Brad include:

  • Avoid external rotation (your arm going behind your head)
  • Avoid abduction (lifting your arm up from your side)
  • Avoid pulling on your arm (which will worsen the dislocation)

Tabletop Rehabilitation Exercises for Shoulder Subluxation

While strengthening the shoulder and arm muscles is important, it’s equally (or arguably more) important to rewire the brain with gentle rehabilitative exercises.

The goal of rehab exercise is less about strengthening the muscle and more about practicing proper movement and mechanics. It’s about relinking mind to muscle.

Rehab exercises should be performed with higher repetition because it helps stimulate the brain and encourage the rewiring process (neuroplasticity).

Here are some great shoulder subluxation exercises after stroke from Barbara, OTA.

Tabletop Punching Movement

occupational therapist demonstrating shoulder subluxation exercises after stroke
finishing position for shoulder subluxation exercise after stroke

Place your forearm on a table pointing straight ahead at 12 o’clock. Then, place a water bottle right in front of your hand.

Make a fist, and then gently “punch” the water bottle forward. Be sure to do this gently and slowly. Then move back to starting position.

Use your non-affected side to bring the water bottle back towards you, and repeat 10 times.

Stop this exercise immediately if it creates pain.

Shoulder Pushing Movement

Place your forearm on the table with your arm pointing at 12 o’clock, and place the water bottle near the inside of your wrist.

Then, push the water bottle towards your body while keeping your elbow glued to your side and your forearm on the table, similar to the movement of a windshield wiper. Stop the exercise here and complete 10 repetitions.

Stop this exercise immediately if it creates pain.

Kinesio Taping

Another technique that may be effective to retrain the brain and muscles to reduce shoulder subluxation is kinesio taping. This involves placing gently stretched pieces of kinesio tape on your upper arm and shoulder to stimulate the muscles.

The tape will provide a light supportive pull to remind your muscles to work to pull the humerus back into the shoulder joint. This may also help to reduce pain. Ask your therapist which kinesio taping method may be appropriate for you.

Adding Electrical Stimulation to Shoulder Subluxation Rehabilitation

electrical stimulation machine for shoulder subluxation after stroke

When the arm is completely paralyzed, one of the best ways to introduce movement is with electrical stimulation.

Your brain communicates with your muscles using electrical impulses, and e-stim helps facilitate this process.

Electrical stimulation helps reconnect your mind to muscle by telling your brain, “Hey! There’s an arm here! Let’s get it together!”

Electrical stimulation helps “wake up” the muscles around your shoulder and, in time, your arm will go back into its socket.

You should consult your therapist to find the best settings and placements for the electrodes. 

Also, even if your arm is not paralyzed, electrical stimulation may still help.

Studies have shown that combining electrical stimulation with rehabilitative exercise leads to better results that rehab exercise alone.

Getting Your Shoulder Back on Track

Practicing shoulder subluxation rehab exercises will help reteach the brain how to control those muscles. With time and gentle practice, the arm may slowly go back into the socket.

Be sure to consult with your therapist to ensure that it’s safe to proceed with these exercises. Also ask your therapist about electrical stimulation and kinesio taping.

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