What is the initial management for inferior subluxation of the shoulder joint?

Initial Management for Inferior Subluxation of the Shoulder Joint

For inferior subluxation of the shoulder joint, proper positioning and use of supportive devices and slings is the recommended initial management approach. 1

Assessment

• Perform a comprehensive clinical assessment including:
  • Musculoskeletal evaluation 1
  • Evaluation of spasticity 1
  • Identification of subluxation severity 1
  • Testing for regional sensory changes 1
• Ultrasound may be used as a diagnostic tool to identify soft tissue injuries associated with the subluxation 1

Initial Positioning and Support

• Position the affected shoulder properly to prevent further subluxation 1
• Consider using supportive devices:
  • Slings during ambulation to protect the shoulder from traction injury 1
  • For wheelchair-bound patients, lap trays and arm troughs can reduce shoulder pain and subluxation 1
• Ensure joints on the paralyzed side are positioned higher than joints proximal to it 1
• Take special care to avoid pulling on the affected arm when repositioning or moving the patient 1

Early Mobilization

• Begin early mobilization when the patient is hemodynamically stable to reduce risk of complications 1
• Avoid overhead pulley exercises as these can worsen the condition 1, 2
• Implement gentle stretching and mobilization techniques, focusing on:
  • Increasing external rotation 1
  • Increasing abduction 1
  • Restoring proper alignment 1

Pain Management

• If no contraindications exist, use analgesics such as acetaminophen or ibuprofen for pain relief 1, 2
• Consider neuromuscular electrical stimulation (NMES) for shoulder pain management 1
• For cases with spasticity-related pain, botulinum toxin injection to the subscapularis and pectoralis muscles may be beneficial 1, 2

Education

• Provide patient and family education on proper positioning and range of motion exercises 1
• Ensure healthcare staff are trained in correct handling techniques to prevent further injury 2

Rehabilitation Approach

• Active range of motion should be gradually increased while restoring alignment and strengthening weak muscles in the shoulder girdle 1
• Implement a structured rehabilitation program focusing on:
  • Gentle stretching exercises 1
  • Maintenance of shoulder range of motion 1
  • Motor retraining 1

Monitoring for Complications

• Regularly assess for signs of complex regional pain syndrome (shoulder-hand syndrome) 1, 2
• Monitor for development of adhesive capsulitis, which is a common cause of shoulder pain in patients with subluxation 3

Advanced Interventions (if initial management fails)

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

Remember that there is no clear correlation between the degree of subluxation and pain severity 3, so treatment should focus on both managing the subluxation and addressing pain through appropriate interventions.