A critical review of shoulder subluxation and its association with other post-stroke complications

Objectives: Shoulder subluxation affects up to 81% of patients with stroke and has been the subject of clinical research studies for decades. Despite this, its role in upper limb recovery is poorly understood. Subluxation has been linked to other post-stroke complications such as pain, restricted range of motion, poor motor recovery and reflex sympathetic dystrophy. The aim of the present study is to synthesise research findings on the association between subluxation and other post-stroke complications. Methods: A critical review of the relevant literature was undertaken. Results: The association between shoulder subluxation and post- stroke complications is equivocal. The majority of studies were found to have methodological limitations such as heterogeneous patient recruitment criteria, small sample sizes, lack of a standardised definition of subluxation and the use of varied and insensitive clinical measures of assessment. Discussion: Although the association between subluxation and post- stroke complications is uncertain, when present in combination, these complications could have a significant impact on upper limb function. Early rehabilitation programmes which target shoulder muscle function may be the best approach to the prevention of secondary complications and the facilitation of motor recovery in the upper limb. Future longitudinal studies with more homogenous samples are needed. These should consider assessing patients at multiple times and follow them up for at least 1 year. The use of prediction models would allow understanding of a causal association between subluxation and other post- stroke complications. This would inform the effective rehabilitation of upper limb dysfunction in patients with stroke.