Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability.

BACKGROUND The aim of the study was to evaluate the incidence of shoulder subluxation in stroke patients and the impact of rehabilitation and presence/absence of fluid in the subhumeral and subdeltoid bursae on the occurrence of instability. MATERIALS AND METHODS The study group was composed of 182 patients after stroke, with 108 men and 74 women. 156 of the patients had suffered an ischemic stroke whereas 26 had experienced a hemorrhagic stroke; 90 patients had right-sided paresis and 92 left-sided paresis. The study variables were evaluated by performing, on two occasions, an ultrasound examination of the shoulder and an assessment of upper limb functional capacity using the Brunnström scale. 182 patients of the study group participated in an exercise programme according tothe PNF concept. RESULTS There was no subluxation of the shoulder on the healthy side, while on the paretic side, subluxation occurred in 25.3% of the patients. Bursal fluid was seen more frequently on the paretic side (12.6%). A statistically significant reduction of the subluxation and bursal fluid was achieved after the rehabilitation. Subluxation occurred more frequently in patients with a known presence of fluid in the bursae and in those with poorer functional capacity of the upper limb. CONCLUSIONS 1. The clinical symptoms of stroke are the cause of subluxation in the shoulder joint. 2. Subluxation occurs more frequently in patients with a known presence of fluid in the subhumeral and subdeltoid bursae and in patients with reduced functional capacity. 3. The reduction of subluxation and bursal fluid was influenced by the exercise program and improved functional capacity.