Glenohumeral subluxation in hemiplegia

Abstract

Malalignment, most commonly, inferior subluxation, is a common and troublesome complication of hemiplegia. Altered scapular and humeral positions have been implicated as a causative factor in glenohumeral subluxation, contributing to upper extremity pain and malalignment. The purpose of this study was to evaluate the relationship between scapular and humeral positions and glenohumeral subluxation in two groups of hemiplegic patients, one with low tone or flaccid paralysis and the other with high tone or spasticity. Thirty-four hemiplegic subjects (17 in each group) participated in this study, ranging in age from 41 to 89 years. Radiographs of the affected shoulder were taken in order to evaluate glenohumeral subluxation. The 3Space Isotrak, an electromagnetic device, was used to obtain the tridimensional co-ordinates of bony landmarks located on the scapula, humerus and vertebral column. Glenohumeral subluxation was significantly greater in the low tone group (0,52 ± 0,38 cm) compared to the high tone group (0,21 ± 0,41 cm) ( p p < 0.05). There was no correlation between scapular and humeral orientation and glenohumeral subluxation vvithin groups and across subjects, hi the low tone group, the scapular abduction angle (AbSc) was significantly lower on the affected side compared to the non-affected side. No significant difference was found in the abduction angle of the humerus (AbH) or in the humeral angle relative to the scapula (HRel). No significant differences were found between the affected and nonaffected sides when the scapular and humeral orientation measures were compared in the high tone group.