Management of the Hemiplegic Shoulder Complex

Hemiplegia in the upper limb and shoulder complex is a common secondary impairment resulting from a cerebrovascular event; evidence-based intervention is required for effective treatment. Prior to addressing shoulder movement, biomechanical alignment of the pelvis and trunk must first be assessed. Extreme care must be taken when completing passive range of motion with the hemiplegic shoulder; motion should not exceed beyond 90 degrees of shoulder flexion and abduction without scapular upward rotation and humeral head external rotation. It is recommended that the use of slings with upper limb hemiplegia be limited. A subluxation of the shoulder can be treated with surface neuromuscular electrical stimulation if the recommended protocol of 6 hours daily, 5 days a week, for 6 weeks is utilized. Taping/strapping for a subluxation has conflicting evidence for reducing the development of hemiplegic shoulder pain, and it does not improve upper limb function or range of motion.