Shoulder subluxation in CVA

1. What is the Basmajian principle and how does it contribute to shoulder subluxation in CVA?
2. What are the pros and cons to a shoulder sling?
3. What are treatments for shoulder subluxation?
4. How can subluxation be prevented?

Answers:
1. Decreased trapezius tone causes the scapula to rotate and the humeral head to sublux from the glenoid fossa.
2. Shoulder slings are not indicated for subluxation, but may be used when patient ambulates to support extremity. Cons include the development of contractures in shoulder adduction/int rot and elbow flexion.
3. Functional e-stim, armboard, arm trough, lapboard, overhead slings (also prevents hand edema).
4. Combining the early reactivation of shoulder musculature with e-stim, passive support of the glenohumeral jt (arm trough).