SUBLUXATION.docx

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1. Bangladesh Health Professions Institute
Department of Occupational Therapy
Masters of Science in Occupational Therapy
Occupational Therapy in Adult Neurology

Subluxation is a condition where there is a partial dislocation of a joint, typically occurring when the joint's
supporting ligaments are damaged or weakened. In the context of stroke, subluxation most commonly
refers to shoulder subluxation, which is a frequent complication seen in individuals who have experienced
a stroke.
Shoulder subluxation in stroke patients usually affects the glenohumeral joint (the joint connecting the
upper arm bone, the humerus, to the shoulder blade, the scapula). Due to weakness and reduced control
of the muscles around the shoulder, the head of the humerus may partially slide out of the shoulder
socket.
The signs and symptoms of shoulder subluxation can vary depending on the severity of the condition. In
shoulder subluxation, the humeral head (upper arm bone) is partially displaced from the glenoid fossa
(the socket of the shoulder joint) but is not completely dislocated. Common signs and symptoms of
shoulder subluxation include:
1. Shoulder Pain: Pain is one of the most common symptoms of shoulder subluxation. The pain is typically
felt in the front or top of the shoulder, and it may worsen with movement or when pressure is applied to
the joint.
2. Shoulder Instability: Patients with shoulder subluxation may report a feeling of instability in the
shoulder joint. They may describe the sensation of the arm feeling loose or like it might pop out of the
socket.
3. Visible Displacement: In some cases, a visible or palpable shift in the position of the shoulder joint may
be noticeable. The humeral head may appear slightly lower or forward compared to the unaffected side.
4. Limited Range of Motion: Shoulder subluxation can result in restricted range of motion in the affected
shoulder. The patient may have difficulty lifting the arm or performing overhead movements.
5. Weakness in Arm Movements: Due to the instability of the joint, patients may experience weakness in
arm movements. They may have difficulty performing tasks that require lifting, pushing, or pulling.
6. Muscle Spasms: Some individuals with shoulder subluxation may experience muscle spasms around the
shoulder joint, which can contribute to pain and further joint instability.
7. Functional Impairment: Shoulder subluxation can significantly affect daily activities. Patients may have
difficulty dressing, reaching for objects, or performing other routine tasks.
8. Guarding Behavior: Patients may adopt a protective posture or guarding behavior to minimize pain and
avoid movements that exacerbate the shoulder instability.
It is important to note that shoulder subluxation is more common in stroke patients due to the muscle
weakness and imbalances resulting from the neurological effects of the stroke. Prompt evaluation and
appropriate management are essential to prevent further complications and improve functional

2. outcomes. Healthcare professionals, such as physical therapists or orthopedic specialists, can conduct a
thorough assessment to diagnose shoulder subluxation and develop a personalized treatment plan, which
may include physical therapy, exercises to strengthen the shoulder muscles, and the use of supportive
devices like slings or braces to stabilize the joint.
The mechanism of shoulder subluxation in stroke is mainly related to the neurological deficits caused by
the stroke itself, specifically hemiparesis or hemiplegia, which refers to weakness or paralysis on one side
of the body, typically the side opposite to the brain lesion. Several factors contribute to the development
of shoulder subluxation in stroke patients:
1. Weakness and Muscle Imbalance: Stroke often leads to damage in specific areas of the brain responsible
for controlling movement. This damage results in weakness or paralysis of the muscles around the
shoulder joint on the affected side. The weakened muscles cannot adequately support and stabilize the
humeral head (upper arm bone) within the glenoid fossa (the socket of the shoulder joint).
2. Reduced Muscle Tone: Stroke can cause a condition known as flaccidity, where the affected muscles
lose their tone and become limp. The loss of muscle tone further contributes to the inability of the muscles
to provide proper support and stability to the shoulder joint.
3. Abnormal Muscle Synergies: Stroke survivors may develop compensatory movement patterns to
perform tasks despite their physical limitations. These abnormal muscle synergies can place additional
stress on the shoulder joint, increasing the risk of subluxation.
4. Impaired Sensation: Stroke can result in sensory deficits, including reduced proprioception (the ability
to sense the position and movement of body parts) on the affected side. Diminished proprioceptive input
can prevent the person from recognizing the joint's improper position, leading to unintentional
movements that contribute to subluxation.
5. Increased Tone in Opposing Muscles: The unaffected side may exhibit increased muscle tone or
spasticity, pulling the shoulder joint downward and outward, further contributing to the subluxation on
the affected side.
6. Effects of Gravity: The combination of gravity and the weight of the arm can also contribute to the
downward and outward pulling forces on the humerus, making it more likely to partially dislocate from
the shoulder socket.
7. Activities of Daily Living: Repetitive activities and movements, such as transferring, reaching, or using
the affected arm during daily activities, can further strain the weakened shoulder joint, increasing the risk
of subluxation.
To manage and prevent shoulder subluxation in stroke patients, a multidisciplinary rehabilitation
approach is crucial. This approach typically includes physical therapy, occupational therapy, and
sometimes assistive devices like slings or braces. Specific exercises to strengthen the shoulder muscles,
improve proprioception, and teach proper movement patterns can help reduce the risk of subluxation
and improve overall shoulder function and stability. Early and targeted intervention can lead to better
outcomes and increased independence for stroke survivors.
Shoulder subluxation refers to the partial dislocation of the glenohumeral joint, which is the joint
connecting the upper arm bone (humerus) to the shoulder blade (scapula). There are different types of

3. shoulder subluxation based on the direction of displacement and the structures involved. The main types
of shoulder subluxation are:

1. Anterior Shoulder Subluxation: This is the most common type of shoulder subluxation. In anterior
subluxation, the humeral head partially moves forward and downward relative to the glenoid fossa of the
scapula. This type of subluxation is often associated with injuries to the anterior shoulder capsule and
ligaments.
2. Posterior Shoulder Subluxation: Posterior subluxation occurs when the humeral head partially moves
backward and inward relative to the glenoid fossa. It is less common than anterior subluxation and is often
associated with trauma, seizures, or certain medical conditions affecting muscle tone.
3. Inferior Shoulder Subluxation: Also known as inferior humeral subluxation or luxatio erecta, this type
of subluxation involves the humeral head displacing downward below the glenoid fossa, sometimes even
below the shoulder joint. It is a rare and severe form of shoulder subluxation usually caused by significant
trauma.
4. Multidirectional Shoulder Subluxation: In this type of subluxation, the humeral head moves in multiple
directions, including anterior, posterior, or inferior. Multidirectional shoulder subluxation is often
associated with joint laxity, ligamentous hypermobility, or conditions like Ehlers-Danlos syndrome.
5. Recurrent Shoulder Subluxation: Recurrent subluxation refers to repetitive or chronic episodes of
partial shoulder dislocation, where the joint partially displaces and then returns to its normal position. It
can be observed in various types of shoulder subluxations and is often associated with underlying joint
instability or muscle weakness.

The management of shoulder subluxation depends on the specific type and severity of the subluxation,
as well as the underlying cause. Treatment may include physical therapy to strengthen the shoulder
muscles, supportive slings or braces, and exercises to improve joint stability and range of motion. In more
severe cases or cases with recurrent subluxations, surgical intervention may be necessary to address
structural issues and stabilize the joint. A thorough evaluation by a healthcare professional is essential to
determine the appropriate treatment approach for shoulder subluxation.