Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients

Objective: To examine the relation between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients. Design: Case-control study. Setting: Inpatient rehabilitation hospital. Patients: Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in the study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded. Main Outcome Measures: Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points. Results: Glenohumeral subluxation was found in 74.3% of the RSD and 40% of the non-RSD group (p = .004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (p = .019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (p = .152). Conclusion: Findings from this study suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients.