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shoulder subluxation:
A concern for
neuroscience nurses
By Cydnee Seneviratne, subluxation through consistent range-of-motion exercises
Karen L. Then, and Marlene Reimer and the efficacy of electrical stimulation as a preventive
therapy (Ada & Foongchomcheay, 2002; Gilmore,
Abstract Spaulding, & Vandervoort, 2004; Price & Pandyan, 2001;
Approximately 84% of all stroke patients with hemiplegia Rathfon, 1994; Spaulding, 1999; Teasell et al., 2004;
will experience shoulder injury and pain. The importance Turner-Stokes & Jackson, 2002; Vuagnat & Chantraine,
of maintaining proper posture while positioning and 2003; Walsh, 2001). In addition, therapists and nurses have
transferring a stroke patient is key to decreasing risk for multiple definitions of what causes post-stroke subluxation
shoulder injury. Shoulder subluxation injury post-stroke is and shoulder pain, which has led to uncertainty around
a consequence of sustained hemiplegia and spasticity. each disciplines role in prevention of this injury
Current research evidence suggests that using therapies (Pomeroy, Niven, Barrow, Faragher, & Tallis, 2001).
such as gentle range of motion and functional electrical Nurses not only have multiple definitions about the cause,
stimulation may reduce and prevent shoulder subluxation but also are generally unaware of interventions to treat and
and hemiplegic shoulder pain. However, physiotherapists champion the prevention of shoulder subluxation and
are currently the only professionals who can implement shoulder pain post-stroke.
such therapies. Considering that stroke care provided by However, physiotherapists are currently the only
neuroscience nurses includes transferring, positioning professionals who are consistently implementing such
and assisting in activities of daily living, it is clear that therapies. Stroke care provided by neuroscience nurses
nurses are an important part of the therapy process. includes range-of-motion exercises, transferring,
Therefore, the question is: What is the role of the positioning and assisting in activities of daily living.
neuroscience nurse in the reduction and prevention of These nursing interventions are rehabilitative in nature,
shoulder pain post-stroke? The purposes of this paper which clearly indicates that neuroscience nurses are an
are to i) discuss the causes of shoulder subluxation and important part of an interdisciplinary team and must
related pain post-stroke, ii) review current best practice in champion best practices in stroke rehabilitation
prevention and treatment of shoulder subluxation, and iii) (Goulding, Thompson, & Beech, 2004). The purposes of
explore ways in which the acute neuroscience nurse can this paper are to discuss the causes of shoulder
prevent or reduce shoulder subluxation in the hemiplegic subluxation and related pain post-stroke, review current
stroke patient. best practice in prevention and treatment of shoulder
Stroke is the primary cause of long-term adult disability in subluxation and explore ways in which the acute
Canada (Canadian Stroke Network, 2004). Hemiplegia is a neuroscience nurse can prevent or reduce shoulder
common disability experienced post-stroke. As many as subluxation in the hemiplegic stroke patient.
84% of stroke survivors with hemiplegia will develop
shoulder subluxation and related shoulder pain (Teasell, Post-stroke shoulder subluxation
Bhogal, Foley, & Speechley, 2004). Currently, there is Stroke patients who have upper extremity hemiplegia as a
much clinical discussion by physiatrists, nurses and lingering deficit are at risk for shoulder injury and related
therapists who work in the area of stroke rehabilitation pain. Possible causes of shoulder pain are spasticity of
about shoulder pain and subluxation post-stroke. Clinical shoulder, which occurs after an initial stage of flaccidity,
discussions range from proper positioning and proper restricted shoulder range of motion and contractures,
range of motion to the use of electrical stimulation therapy sustained hemiplegic posture and shoulder
to strengthen shoulder muscles as an adjunct to (glenohumeral) subluxation (Ada & Foongchomcheay,
physiotherapy exercises. Most stroke rehabilitation 2002; Moskowitz, Goodman, Smith, Balthazar, &
discussion and research papers examine and explore Mellins, 1969; Teasell et al., 2004; Tobis, 1957).
treatment of shoulder pain, management of shoulder However, controversy exists regarding whether shoulder
References
Ada, L., & Foongchomcheay, A. (2002). Efficacy of Alexander, T.T., Hiduke, R.J., & Stevens, K.A. (1999).
electrical stimulation in preventing or reducing subluxation of the Rehabilitation nursing procedures manual (2nd ed.). New
shoulder after stroke: A meta-analysis. Australian Journal of York: McGraw-Hill.
Physiotherapy, 48, 257-267.