Initial Management for Inferior Subluxation of the Shoulder Joint

Assessment

A comprehensive clinical assessment, including musculoskeletal evaluation, evaluation of spasticity, identification of subluxation severity, and testing for regional sensory changes, should be performed to guide management of inferior subluxation of the shoulder joint 1
Ultrasound may be used as a diagnostic tool to identify soft tissue injuries associated with the subluxation 1

Proper positioning of the affected shoulder is crucial to prevent further subluxation, and supportive devices such as slings and lap trays can be used to protect the shoulder from traction injury 1, 2
For wheelchair-bound patients, lap trays and arm troughs can reduce shoulder pain and subluxation 2
Ensuring joints on the paralyzed side are positioned higher than joints proximal to it can help prevent subluxation 3
Special care should be taken to avoid pulling on the affected arm when repositioning or moving the patient to prevent further injury 3

Early mobilization should be started when the patient is hemodynamically stable to reduce the risk of complications, and gentle stretching and mobilization techniques should be implemented to increase external rotation, abduction, and restore proper alignment 1, 3, 5
Overhead pulley exercises should be avoided as they can worsen the condition 1, 4

Analgesics such as acetaminophen or ibuprofen can be used for pain relief if there are no contraindications, and neuromuscular electrical stimulation (NMES) can be considered for shoulder pain management 1, 5
Botulinum toxin injection to the subscapularis and pectoralis muscles may be beneficial for cases with spasticity-related pain 1, 5

Patient and family education on proper positioning and range of motion exercises is essential to prevent further subluxation and promote recovery 1

A structured rehabilitation program focusing on gentle stretching exercises, maintenance of shoulder range of motion, and motor retraining should be implemented to restore alignment and strengthen weak muscles in the shoulder girdle 2, 5
Active range of motion should be gradually increased while restoring alignment and strengthening weak muscles in the shoulder girdle 5

Regular assessment for signs of complex regional pain syndrome (shoulder-hand syndrome) is crucial to prevent long-term complications 5

Suprascapular nerve blocks may be considered as an adjunctive treatment for persistent hemiplegic shoulder pain, and surgical options like tenotomy of pectoralis major, lattisimus dorsi, teres major, or subscapularis muscles may be considered for severe cases with spasticity and restricted range of motion 1, 6