The shoulder is the most common source of pain for stroke survivors. As many as 84% of stroke survivors develop shoulder pain associated with shoulder subluxation and motor weakness. The space on the lateral aspect of the shoulder joint should be less than one-finger width. The more finger widths of separation, the more severe of the subluxation. Proper shoulder support is key to prevention and treatment.
But what is shoulder subluxation and what causes it? For stroke survivors, it’s usually caused by weak rotator cuff muscles, which connect the upper arm bone to the shoulder blade. These muscles are responsible for maintaining shoulder joint alignment during arm movement. When the rotator cuff is weak, gravity pulls the arm down and away from the shoulder blade, causing shoulder subluxation.
In many cases, the tightness of tonic muscles such as Pectoralis major and Subscapularis can pull the head of Humerus forward and away from the shoulder blade. Slouched posture caused by weak core muscles can also increase shoulder subluxation.
Here are some prevention and management strategies to eliminate post-stroke shoulder pain:
- Scalp acupuncture (Shoulder and upper extremity zones
- Electro-acupuncture on LI15, SJ14, SI11 and Ashi point on the posterior border of proximal Humerus (Insertion of subscapularis).
- Encourage active movements in the pain-free range.
- Strengthen Shoulder phasic muscle groups like Deltoid, Supraspinatus Infraspinatus and Teres minor.
- Stretch shoulder tonic muscle groups such as Pectoralis major and Subscapularis.
The shoulder pain and risk for shoulder subluxation can definitely decrease with proper treatments. But make sure the shoulder joint is protected during all exercise and training activities. 👍