Shoulder subluxation after stroke can be quite puzzling for therapists to treat. Can these three treatment methods save a shoulder?
How a shoulder subluxation rears its ugly head can vary greatly–it may develop more quickly with some patients than others, it may be painful or even go completely unnoticed. As therapists, regardless of the how or when, we consistently try to prevent shoulder subluxation from happening and reduce the severity if it does happen… but are we truly being effective?
Should we be grabbing that sling to support their shoulder? Does e-stim help reduce the degree of translation? Is taping effective for prevention? Let’s dive in and strengthen our evidence-based application.
For strategies on how to help your patients maintain dignity and respect when dealing with dysphagia after stroke, download our ‘Say This, Not That’ handouts here!
Why does Shoulder Subluxation Happen?

What Interventions are Available…and What Do They Do?
Slings

Clinical Application: It goes without saying that more research needs to be completed (as with many areas of practice), but we should always be striving to tailor our choice of interventions, so they are specific to our patient’s needs. In the case of a sling, there is still a useful application even if it’s not going to make a difference in the degree of shoulder subluxation. A sling could be beneficial in protecting your patient’s limb during transfers, or it may be helpful in reduction of pain associated with subluxation. But if there is no pain and the limb seems to stay in a good position during functional mobility…leaving the sling out of it may be the way to go!
Taping
Prevention & Management: There is minimal evidence clarifying whether taping is effective at prevention of shoulder subluxation, but there is plentiful research that indicates that taping methods–both kinesiology and inelastic tape–can reduce present shoulder subluxation and reduce pain associated with it. Other studies found that while unable to prevent subluxation, specific techniques have been found to result in improvements in shoulder flexion and proximal arm function. Clinical Application: With taping showing consistent results in the reduction of shoulder subluxation and pain, this should be a staple in your stroke rehab toolbox! There may be a few reasons you wouldn’t move forward with this, such as patients with fragile skin or sensitivities to adhesives, but with the equipment being both inexpensive and accessible… we need to be moving our thoughts away from slings and more toward taping!E-stim

Where Do I Go from Here?
Make sure to look at your patient as a whole and see what they specifically need in their plan of care–a blanket plan of action will not be as effective as a patient-centered plan of care. If you are treating your patient in the acute or subacute phase of stroke rehab, e-stim may be a great starting point as a preventative measure. If shoulder subluxation is unfortunately already present, taping would then be a smart move to prevent further separation & pain prevention. If that limb looks unstable during transfers or is causing high pain–it may be time to consider our old friend the sling.So, it’s all about being up to date with the latest research in combination with the clinical presentation and needs of your patient–if something is not working well enough to meet their needs, do not be afraid to move on and try something else!
If you are interested in learning more about Stroke Rehab and upgrading your practice, check out our fantastic, 7 Contact Hour course, In-Patient Stroke Rehab: 14 strategies to get your patient HOME! to get great techniques and tips to get your patients back to where they want to be: back home!

Ruth Polillo, MSPT, CBIS: Ruth graduated with a Master of Science in Physical therapy degree from Thomas Jefferson University in 2005, and has gained experience in every setting a therapist can work in. She is a co-founding member of ARC & an enthusiastic presenter! Ruth is passionate about continuing education and making hands-on clinical skills available to clinicians.