Supportive devices for preventing and treating subluxation of the shoulder after stroke

There is insufficient evidence to conclude that supportive devices are effective in the prevention and treatment of subluxation of the shoulder after stroke. Shoulder subluxation is one of the most common secondary musculoskeletal problems after stroke which can cause pain and hinder the recovery of upper limb function. Supportive devices have traditionally been applied to treat shoulder subluxation. This review of four trials found insufficient evidence to conclude whether supportive devices prevent subluxation or not and found no evidence to conclude whether supportive devices can reposition the head of humerus in the glenoid fossa of an already subluxed shoulder.

Authors' conclusions: 

There is insufficient evidence to conclude whether slings and wheelchair attachments prevent subluxation, decrease pain, increase function or adversely increase contracture in the shoulder after stroke. There is some evidence that strapping the shoulder delays the onset of pain but does not decrease it, nor does it increase function or adversely increase contracture.

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Background: 

Supportive devices such as slings, wheelchair attachments and orthoses have been used to treat subluxation of the shoulder after stroke.

Objectives: 

To investigate the effect of supportive devices in preventing subluxation, re-positioning the head of humerus in the glenoid fossa, decreasing pain, increasing function and adversely increasing contracture in the shoulder after stroke.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (last searched on 22 March 2004). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004), MEDLINE (1966 to March 2004), CINAHL (1982 to March 2004), EMBASE (1974 to March 2004), AMED (1985 to March 2004) and the Physiotherapy Evidence Database (PEDro, March 2004). We also handsearched conference proceedings and contacted authors for additional information.

Selection criteria: 

Studies were included if they were: randomised, quasi-randomised or controlled trials; participants had a stroke; intervention was supportive devices; and subluxation, pain, function or contracture were measured.

Data collection and analysis: 

Two independent reviewers examined the identified studies which were assessed for methodological quality and analysed as (1) supportive devices versus no supportive devices or (2) two supportive devices.

Main results: 

Four trials (one on slings, three on strapping - 142 participants) met the inclusion criteria. One trial testing a hemisling versus no device reported that no participants had subluxation greater than 10 mm, the same number had lost more than 30 degrees of shoulder external rotation (Peto odds ratio (OR) 1.00, 95% confidence interval (CI) 0.1 to 9.3), and more participants in the hemisling group had pain (Peto OR 8.7, 95% CI 1.1 to 67.1). The other three showed that strapping was effective in delaying the onset of pain (weighted mean difference (WMD) 14 days, 95% CI 9.7 to 17.8), but was ineffective in reducing pain severity (WMD -0.7 cm on a visual analogue scale, 95% CI -2.0 to 0.7), increasing upper limb function (WMD 0.8, 95% CI -1.5 to 3.1) or affecting the degree of contracture (WMD -1.4 degrees, 95% CI -10.9 to 8.1) at the shoulder.

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