For Doctors and Therapists

A shoulder subluxation can begin as early as 72 hours post brain injury
and arm pain typically starts within 2 weeks post stroke!

A neurological shoulder subluxation occurs when a brain injury (such as a stroke) impairs the communication networks between the brain and the muscles in the arm and causes the humeral head to shift out of the glenoid cavity. As many as 81% of stroke survivors who have hemiplegia suffer from a shoulder subluxation during the flaccid stage of recovery [1,2,4, 9-10]. Improper shoulder positioning due to lost muscle tone and lack of upper extremity support contribute to subluxations [1-2, 11] and serve as risk factors for shoulder pain or other secondary upper body complications post stroke [2-4].

As many as 37% of those with a subluxed shoulder from a brain injury also suffer from related shoulder pain that impacts functional rehabilitation progress and quality of life. Hemiplegic shoulder pain and wrist pain are primary obstacles doctors and therapists face when implementing rehabilitative techniques for the upper arm [1-6]. Shoulder pain often results in significant long-term disability, impedes uses of rehabilitation interventions and limits patient’s ability to reach their maximum functional arm potential [6-8].

Current Slings for Shoulder Subluxation Fall Short

Practicing clinicians and research publications frequently describe a myriad of reasons why existing glenohumeral (GH) subluxation products are less than favorable in real-world therapy application:

  • Popular slings maintain support at the shoulder when in standing, but lose their elastic-based bracing when sitting or when the hand is resting on a surface.
  • Most slings strap around the shoulder/upper arm and pull upward, yet subluxation support has been documented to be more effective when it comes from below the elbow.
  • Many existing slings have limited adjustability for spasticity changes or edema management during the differing phases of recovery.
  • Hemiparetic arm slings often strap the opposite shoulder and reportedly cause axillary break down or skin irritations on the less affected side.
  • The complex strapping system on some slings frustrate caregivers and clients to the point of not wanting to wear the device.
  • Several existing arm slings ignore the distal arm leaving the wrist and fingers unsupported and in need of a second support system if the whole arm is flaccid or non-functional.
  • Patients report new pain in their neck, wrist, or axillary region with present-day slings and only tolerate them for short time periods, leading to more time spent unsupported than supported.

For years clinicians and researchers have recognized and discussed the problems of existing interventions for shoulder subluxations and arm pain resulting from neurological injuries. Everyone agrees that something needs to be done, yet no solution has been strongly adopted by the rehabilitation community. Consequently, most existing data suggests that prevention is the key to both glenohumeral subluxations (GHS) and hemiplegic shoulder pain (HSP). Practicing therapists will tell you it is vital that the entire rehab team, including the patient and family members, proactively manage and/or prevent shoulder pain to increase patients’ tolerance for later implementation of neuromuscular education training techniques. Moreover, research specifies early and consistent application of proper biomechanical joint positioning at the shoulder is critical in the rehab process because it supports maintaining normal muscle & soft tissue length around the joint [1, 12-13].

Few innovators have been bold enough to address these long-standing issues presented by current neurological shoulder support systems. Unlike the orthopedic subluxation that can heal in 8-12 weeks, the neurological injury can take multiple months to years to recover. Typical orthopedic sling designs don’t have to account for wrist/hand spasticity or alignment, nor do they have to consider the length of time the device will need to be worn. Devices that support the shoulder subluxation caused by a brain injury need to accommodate numerous changes in muscle tone or edema, various positioning needs of the entire arm, changes in mobility levels and various functional training tasks. Furthermore, they must effectively address the problems of the whole arm without creating new injuries.

The LuxArm Shoulder Subluxation Brace is a Game Changer

The LuxArm is a semi-customizable device that correctly aligns the GH joint after a neurological subluxation, dynamically supports the complex hemiplegic wrist/hand and comfortably removes all shoulder suspension straps. It took over 8 years to develop and called for an unconventional approach that addressed each existing concern directly. Early clinical trials concluded the device can reduce pain throughout the day whether sitting, standing, or walking AND that it can effectively and ergonomically reduce a shoulder subluxation while supporting the distal arm therapeutically.

The LuxArm Shoulder Subluxation Brace has gotten the endorsement from real patients/caregivers, practicing physical & occupational therapists, physiatrists, rehabilitation nurses and has grabbed the attention of college institutions. The configuration of the LuxArm is so thoughtful in its design that is has the potential not only to serve as an intervention for acute neurologically-based glenohumeral shoulder subluxations, but it could also be a possible subluxation prevention device if applied early enough post onset of the initial brain injury.

Anticipating and preventing shoulder problems while simultaneously supporting the ever-changing needs of the recovering hemiplegic arm is truly the direction therapists need and want to take in a proactive and progressive rehabilitation. LuxArm breaks new ground and gives the upper extremity V.I.P. treatment after a brain injury.

Learn more about the LuxArm Shoulder Subluxation Brace and 9 Key Factors that set it apart from all other existing slings.
 
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References:

  1. Turner-Stokes L, Jackson D. Shoulder pain after stroke: A review of the evidence base to inform the development of an integrated pathway. Clin Rehabil. 2002; 16:276-98.
  2. Paci M, Nannetti L, Rinaldi LA. Glenohumeral subluxation in hemiplegia: An overview. J or Rehabil Research & Dev. 2005; 42(4): 557-568.
  3. Paci, M., Nannetti, L., Taiti, P., Baccini, M., Pasquini, J. and Rinaldi, L. Shoulder subluxation after stroke: Relationships with pain and motor recovery. Physiotherapy Research International. 2007; 12: 95–104.
  4. Kumar P, Swinkels A. A critical review of shoulder subluxation and its association with other post-stroke complications. Physical Therapy Reviews.2009; 14(1):13-25.
  5. Gustafsson L, McKenna K. Treatment approaches for clients with a stroke-affected upper limb:Are we following evidence-based practice? Australian Occupational Therapy Journal. 2003; 205-215.
  6. Vuagnat H, Chantraine A. Shoulder pain in hemiplegia revisited: Contributions of functional electrical stimulation and other therapies. J Rehabil Med. 2003; 35: 49-56.
  7. Poduri KR. Shoulder pain in stroke patients and its effect on rehabilitation. J Stroke Cerebrovascular Dis. 1993; 3-261-6.
  8. Rizk TE, Christopher RP, Pinals RS, Salazar JE,Higgins C. Arthrographic studies in painful hemiplegic shoulders. Arch Phys Med Rehabil. 1984; 65: 254-6.
  9. Vuagnat H, Chantraine A. Shoulder pain in hemiplegia revisited: contribution of functional electrical stimulation and other therapies. J of Rehabil Med 2003; 35:49-54.
  10. Ada, L., & Foongchomcheay, A.(2002). Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: A meta-analysis. Australian Journal of Physiotherapy, 48(4), 257-267.
  11. Teasell RW. The painful hemiplegic shoulder. Physical Medicine and Rehabilitation:sState of the Art Reviews. 1998;12(3):489-500.
  12. Shephard RB, Carr JH. The Shoulder Following Stroke: Preserving musculoskeletal integrity for function. Top Stroke Rehabil. 1998; 4:35-53.
  13. Gould R, Barnes SS. Shoulder and Hemiplegia. (February 5, 2009). Retrieved from https://emedicine.medscape.com/article/328793