Annals of Rehabilitation Medicine

Effectiveness of Newly Designed Modified Extension-Type Sling for the Subluxated Shoulder in Hemiplegia.: Yoon, Yong Soon , Choi, Jun Sup , Chung, Bok Hee , Chang, In Su; J Korean Acad Rehabil Med 2010;34(2):150-157.

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Objective
To test the effectiveness of the METS (modified extension-type sling) in reducing subluxation in patients with hemiplegic shoulders, and to assess the functional support of METS as the angle of the elbow changes. Method: Sixteen flaccid hemiplegics were assessed by the anteroposterior shoulder radiographs. Three parameters, vertical distance (VD), horizontal distance (HD) and joint distance (JD), were measured on both affected and unaffected sides before and after the fitting of the METS and the Bobath sling. Three parameters were also measured in each elbow flexion angle (0^o, 30^o, 60^o, 90^o) after the fitting of the METS and extension-type sling with a forearm cuff to evaluate the effectiveness in the dynamic condition. Results: In the Bobath sling, the mean values of VD and JD reduced significantly (p＜0.05), but on the contrary, HD increased significantly (p＜0.05). In the METS, VD and JD reduced significantly (p＜0.05), and there were no changes in HD (p＞0.05). In the Bobath sling, VD, HD and JD were different from the unaffected side (p＜0.05), but in the METS, three parameters were not different from the unaffected side (p＞0.05). As the elbow flexion angle increased with the METS, three parameters were not different from the unaffected side (p＞0.05), but with the extension-type sling with a forearm cuff, VD and JD were different from the unaffected side (p＜0.05). Conclusion: The METS was more effective not only in the reduction of the hemiplegic shoulder subluxation, but also in the maintenance of reduction as the elbow flexion angle changes within various activities. (J Korean Acad Rehab Med 2010; 34: 150-157)

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The Effect of GivMohr Slings on Shoulder Subluxation in Hemiplegic Patients.: Cho, Dong Soo , Cho, Hyung Jun , Park, Seung Buhm , Yun, Seo Ra , Jung, Kwang Ik; J Korean Acad Rehabil Med 2007;31(4):410-416.

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To compare the radiological corrective effect for shoulder subluxation among GivMohr & other slings in hemiplegic patients. Method: Fifteen hemiplegic patients with flaccid upper limb were included. The vertical distance (VD), horizontal distance (HD) & joint distance (JD) on the plain AP views of the shoulders were measured. GivMohr sling was compared with 2 conventional slings, which were forearm cuff type extension sling and Bobath sling, in the effects of correction. Results: The mean values of VD and JD of hemiplegic shoulder increased compared to unaffected side, but those of HD was not different between them. In Bobath sling, VD was significantly reduced and HD was not changed. However, JD was increased as other studies. GivMohr sling and forearm cuff type extension sling showed corrective effect in VD and JD (p＜0.05). When compared with these two slings, there were no significant differences in VD and JD. Conclusion: The results show that GivMohr sling reduces shoulder subluxation as other slings. This new sling is helpful for patients with flaccid upper limbs to reduce shoulder subluxation. (J Korean Acad Rehab Med 2007; 31: 410-416)

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Effects of Functional Magnetic Stimulation on Hemiplegic Shoulder Subluxation.: Sohn, Min Kyun , Cho, Kang Hee , Yoon, Sang Jin , Lee, Tae Sung , Lee, Kwang Jae; J Korean Acad Rehabil Med 2007;31(1):48-55.

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To evaluate the effects of functional magnetic stimulation (FMS) on shoulder subluxation following hemiplegia due to stroke or traumatic brain injury. Method: Twenty-four hemiplegic patients were participated in this study as FMS group (12 subjects) and FES (functional electric stimulation) group (12 subjects). FMS or FES were applied on the supraspinatus and posterior deltoid muscle area for 20 minutes, 5 days a week for 3 weeks. The effect of treatment was evaluated by assessment of the degree of shoulder subluxation using radiologic measurements, pain threshold and pain tolerance pressure, range of motion of the shoulder, muscle power and spasticity. Results: The degree of shoulder subluxation was signifi cantly decreased after 3 weeks in both groups, and the FMS group improved more than the FES group. However there were no differences between two groups significantly. There was no significant effect of disease duration on change of shoulder subluxation. The ranges of motion of shoulder were increased in FMS group significantly. Pain threshold and pain tolerance pressure were increased in pectoralis major and infraspinatus muscles shortly after FMS application. Conclusion: This study suggests that the FMS could be applied effectively in preventing and reducing the shoulder subluxation in patient with hemplegia irrespective of disease duration. (J Korean Acad Rehab Med 2007; 31: 48-55)

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Comparison of Ultrasonographic Findings with Clinical Findings in Hemiplegic Shoulder.: Ko, Myoung Hwan , Kim, Ji Yeon , Park, Sung Hee , Kim, Nam Gyun , Seo, Jeong Hwan; J Korean Acad Rehabil Med 2006;30(3):213-218.

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To identify the etiology of hemiplegic shoulder pain by ultrasonographic and clinical examinations and to determine the correlation between ultrasonographic findings and clinical factors in patients with hemiplegic shoulder. Method: Seventy hemiplegic patients with shoulder pain or without shoulder pain were enrolled. All of patients were evaluated by ultrasonography. We analyzed clinical factors including visual analogue scale (VAS) of hemiplegic shoulder pain, shoulder subluxation measured by plain X-ray, shoulder manual muscle test (MMT), passive range of motion (PROM) of the shoulder joint and complex regional pain syndrome (CRPS). Results: 51.0% of patients with shoulder pain showed ab-normal ultrasonographic findings, while 9.5% of patients without shoulder pain. Those with abnormal ultrasonographic findings had significantly decreased shoulder PROM in flexion, abduction, external rotation and internal rotation and more severe subluxation of hemiplegic shoulder (p＜0.05). Conclusion: After investigating the hemiplegic shoulder through ultrasonography, painful hemiplegic shouder had high incidence of abnormal ultrasonographic characteristics. Ultrasonography is more worthwhile and useful as an primary diagnostic method, especially when there is severe shoulder subluxation and the limitation of PROM of shoulder in hemiplegic patients. (J Korean Acad Rehab Med 2006; 30: 213-218)

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Three Newly Designed Arm Slings for the Stroke Patient with Shoulder Subluxation: A case report.: Park, Jeong Mee , Kim, Ic Soo , Vach, Young W , Lee, Yang Tark , Kim, Sung Hoon; J Korean Acad Rehabil Med 2005;29(1):141-144.

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We reported three types of newly designed arm slings (the "V" strap pouch arm sling, the Modified hemisling, the Tripod arm sling). The three slings and the conventional hemisling were all tested by a single stroke patient for the correction of shoulder subluxation. Sling effectiveness was evaluated by simple shoulder AP X-rays, quantitative electromyography (root mean square; RMS), strap tension, and preference of the patient. Of the four types, the "V" strap pouch arm sling reduced the vertical displacement the most. RMS values of the supraspinatus muscle tended decrease and strap tension was also lower after using the "V" strap pouch arm sling compared with others. The patient also preferred the "V" strap pouch arm sling to the other slings. We suggested that "V" strap pouch arm sling was the most effective among four types of arm slings (including conventional hemisling) for the correction of shoulder subluxation, and patient's preference. (J Korean Acad Rehab Med 2005; 29: 141-144)

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The Effect of Modified Triangular Bobath Slings on Shoulder Subluxation in Stroke Patients.: Yoon, Yong Soon , Kim, Je Hwan , Lee, Kyung Ah , Lim, Jin Taek , Ohm, Bo Young , Chang, In Su , Lim, Ho Yong , Chung, Bok Hee; J Korean Acad Rehabil Med 2004;28(5):494-500.

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Objective
To introduce a Modified triangular Bobath sling (MTBS) and a MTBS with distal support (MTBSDS) as a new slings and to compare with previous slings in the therapeutic effects of shoulder subluxation in stroke patient.Method: Using a simple X-ray with and without slings, the vertical and horizontal distances were measured for 17 stroke patients. MTBS and MTBSDS were compared with 3 conventional slings, which were hemisling, Bobath sling and Extension-type sling, in the effects of correction. The questionaire was used to evaluate preference of patients.Results: In two developed slings, inferior subluxation showed significant correction and lateral displace was lessincreased than a Bobath sling although it was not statistically significant (p＜0.05). MTBS had the preference during non-walking because of comfort and easiness for donning and doffing, whereas MTBSDS had the preference during walking because of reciprocal arm swing and protecting the hemiplegic upper extremity from trauma.Conclusion: The results indicated MTBS and MTBSDS were more effective on shoulder subluxation in stroke patients. Further study on the development of slings for decrement of lateral displacement is recommended. (J Korean Acad Rehab Med 2004; 28: 494-500)

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Two Different Types of Extension Arm Sling to Compare the Reduction of Shoulder Subluxation in Hemiplegic Patients.: Park, Joo Hyun , Park, Geun Young , Whang, In Sik , Sung, Jin Young; J Korean Acad Rehabil Med 2004;28(1):26-30.

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Objective
The purpose of this study was to compare the reduction of shoulder subluxation radiologically using two types of extension arm sling. Method: Fifteen patients with a hemiplegic shoulder subluxation were studied. Two types of extension sling (forearm cuff type and humeral cuff type) were applied for the shoulder subluxation. On the shoulder X-ray, three parameters were measured: vertical distance (VD), horizontal distance (HD), and joint distance (JD). Results: The mean values of the VD, HD, and JD of hemiplegic shoulder without a sling were 2.00⁑0.69 cm, 2.69⁑0.45 cm, and 1.53⁑0.56 cm, respectively, which were reduced to 1.00⁑0.43 cm, 2.61⁑0.46 cm, and 0.80⁑0.37 cm by a forearm cuff type and to 1.80⁑0.83 cm, 2.60⁑0.45 cm, and 1.33⁑0.66 cm by a humeral cuff type. A forearm cuff type showed corrective effect in VD and JD, but a humeral cuff type did not in any of three parameters. When compared with nonhemiplegic side, there was no significant difference in VD and JD with a forearm cuff. But a humeral cuff showed significant difference in all parameters. So a forearm cuff type showed corrective effect this time. Conclusion: A forearm cuff type extension arm sling was a more effective orthosis for the reduction of the hemiplegic shoulder subluxation than a humeral cuff type extension arm sling. (J Korean Acad Rehab Med 2004; 28: 26-30)

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Assessment of Shoulder Subluxation Using the Lateral Scapular Slide Test in Hemiplegic Patients.: Yoon, Yong Soon , Jung, Seung Suk , Lee, Kyung Ah , Kim, Je Hwan , Lim, Jin Taek; J Korean Acad Rehabil Med 2003;27(6):819-823.

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Objective: This study was designed to investigate the correlation between the lateral scapular slide test (LSST) and shoulder subluxation, scapular position, pain on movement, Brunnstrom stage in hemiplegic patients.

Method: 20 hemiplegic patients (right: 10, left: 10) were evaluated LSST in resting position at three different points (T2-Superior Angle, T3-Scapular Spine, T7-Inferior Angle) in three times of the both shoulder. Muscle power of shoulder, Brunnstrom stages, spasticity, subluxation degrees using X-ray studies and ROM pain degrees using Visual Analog Scale (VAS) were also evaluated to examine the clinical correlation.

Results: This study showed the evidence of positive correlation with LSST and shoulder subluxation, ROM pain degrees using VAS at T7-inferior angle (p＜0.05), and negative correlations with LSST with shoulder abduction muscle power and Brunnstrom stage. But, there were no correlations with shoulder spasticity and hemiplegic side.

Conclusion: This study provided LSST can be a useful predictor of shoulder subluxation and it supposed that the glenoid fossa on the affected side was upward rotated compared to the unaffected side. (J Korean Acad Rehab Med 2003; 27: 819-823)

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A Newly Designed Sling for Hemiplegic Shoulder Subluxation: A Pilot Study.: Han, Tai Ryoon , Paik, Nam Jong , Kim, Dai Youl , Kim, You Soo , Park, Ji Hong; J Korean Acad Rehabil Med 2003;27(5):661-666.

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Objective
To introduce a newly designed arm sling and to compare the effects on a shoulder subluxation.

Method: Sixteen hemiplegic patients with shoulder subluxation were evaluated by a simple X-ray with and without the slings and the vertical and horizontal distances on the plain AP views were measured. The newly designed arm sling was compared in terms of the effects of correction with a pouch sling and a Bobath sling. The arm sling designed for this study was developed for the purpose of maintaining patients' hands in a functional position and performing ROM exercise of the shoulder easily. The mean values of the vertical and horizontal distance were compared to determine if there was significant difference of function between the new sling and the conventional slings. Variables such as comfort, choice, and easiness for donning and doffing of the arm slings were evaluated by questions.

Resuts: The new sling provided the patients with good vertical correction of the subluxation (p＜0.05) but did not increase the horizontal distance significantly. According to the responses to the questions, the new sling was more comfortable than the conventional slings.

Conclusion: These results support the effectiveness and the comfort of a new sling to decrease subluxation in hemiplegia. Further study on the long term effects or complication of the new sling is recommended.

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Shoulder Subluxation and Risk of Complex Regional Pain Syndrome after Stroke.: Lim, Jae Young , Cho, Hyun Woo , Lee, Kyu Bum , Shin, Hyung Ik , Kim, Ji Young , Kim, Wan Ho , Kim, Byung Sik; J Korean Acad Rehabil Med 2003;27(1):21-26.

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Objective
To evaluate the frequency of complex regional pain syndrome (CRPS) and to determine the risk of CRPS after stroke according to the degree of shoulder subluxation by quantitative radiographic analysis.

Method: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2⁑10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa.

Results: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p＜0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS.

Conclusion: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS. (J Korean Acad Rehab Med 2003; 27: 21-26)

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Anterior Displacement of Humeral Head in Hemiplegic Shoulder Subluxation.: Cheong, Jee Young , Shin, Hye Sung , Han, Soo Jeong , Hwang, Jeong Hye , Lee, Chyung Ki; J Korean Acad Rehabil Med 2002;26(6):658-666.

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Objective
To measure anterior displacement of the humeral head and to observe its relationship with clinical findings in the subluxed hemiplegic shoulders. Method: Seventeen hemiplegic patients, having the subluxed shoulder over one finger breadth were subjected. We measured shoulder pain, muscle power of the shoulder abductors, Brunnstrom stage and spasticity in the affected upper extremity. To measure the humeral displacement of the shoulder subluxation, the AP and transthoracic lateral views of simple radiologic picture were taken on both affected and unaffected shoulders, and repeated after donning three kinds of arm slings. Results: Its anterior displacement as well as the inferior displacement occured in all subjects, and was significantly related with the value of shoulder pain and spasticity, and the inferior displacement with Brunnstrom stage and muscle power of the shoulder abductors in the subluxed hemiplegic shoulder (p＜0.05). Correction of the humeral displacement occured significantly in anterior direction as well as inferior by use of all tested arm slings. Conclusion: Clinical implications of the shoulder subluxation were different according to direction of the humeral displacement, and anterior displacement will be considered for its symptom in hemiplegic shoulder. (J Korean Acad Rehab Med 2002; 26: 658-666)

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The Effect of Functional Electrical Stimulation on Hemiplegic Shoulder Subluxation.: Kim, Kee Kyung , Kang, Min Joung , Shin, Oh Soo , Im, Min Sik , Lee, Kyeong Hwan , Park, Si Woon , Kim, Byung Sik; J Korean Acad Rehabil Med 2000;24(3):402-409.

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Objective: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients.

Method: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment.

Results: 1) The severity of subluxation was significantly increased after 6 weeks (p＜0.05) in the control group. In the study group, it was reduced but the difference was not statistically significant (p＞0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period.

Conclusion: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.

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Shoulder Subluxation in Hemiplegia: Comparison of Therapeutic Effects of Four Different Types of Slings.: Chon, Joong Son , Chun, Sae Il , Choi, Eun Hee , Kim, Sang Hyun; J Korean Acad Rehabil Med 1998;22(1):210-216.

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The purpose of this study is to compare the effectiveness of the Rolyan, hemisling, remodified Bobath, and the newly designed triangular Bobath slings. Sixteen patients with a shoulder subluxation were evaluated by the simple shoulder AP X-rays with and without slings. The hemisling was applied with the elbow flexed at 90 and 120 degrees. The radiologic evaluation for the detection of shoulder subluxation was done by measuring the vertical and horizontal displacement on a plain AP view. The mean value of vertical displacement without a sling application was 5.21 cm which was reduced to 4.30 cm by a triangular Bobath sling application and 4.32 cm by a hemisling application at 120°elbow flexion. These two slings significantly corrected the vertical displacement, but other were not. In nine of sixteen patients, the triangular Bobath sling was the best sling for the vertical correction. All slings except a hemisling increased the horizontal displacement even though it was not statistically significant. The triangular Bobath sling improved the discomfort of the axilla better than the remodified Bobath sling.

The results support that the triangular Bobath sling was the best among 4 slings for the correction of shoulder subluxation, although a reduction in lateral displacement and an improvement in applicability need to be explored further.