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Lee, Jeon, Jeong, Kim, and Sim: Factors Associated with Post Stroke Shoulder Subluxation
Original Article

Kosin Medical Journal 2015;30(1):59-67.

Published online: 20 January 2015

DOI: https://doi.org/10.7180/kmj.2015.30.1.59

Factors Associated with Post Stroke Shoulder Subluxation

Jae Hyun Lee1, Woo Hyun Jeon2, Ho Joong Jeong1, Ghi Chan Kim1, Young Joo Sim1,

1Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea

2Department of Physical Medicine and Rehabilitation, Dong Eui Hospital, Busan, Korea

Corresponding Author：Young Joo Sim, Department of Physical Medicine and Rehabilitation, College of Medicine, Kosin University, Gospel Hospital, 262, Gamcheon-ro, Seo-gu, Busan, Korea TEL: +82-51-990-6261 FAX: +82-51-241-2019 E-mail: oggum@naver.com

Received 12 September 201315 January 2014       Accepted 3 February 2014

Copyright © 2015 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Shoulder subluxation is common complication after stroke. And it can result in delayed neurological recovery in hemiplegic stroke patients. The aim of this study is identifying the incidence and associating factors of shoulder subluxation in stroke patients.

Methods

Stroke patients from 1 rehabilitation center from January 2008 to January 2012 were enrolled in the present study. The basic demographic data were registered at the time of admission or transfer to rehabilitation center. To assess the shoulder subluxation, we have used fingers'breadth method and plain radiography. We diagnosed shoulder subluxation with vertical distance (VD) were more than 12.4cm on plain anteroposteior view. And then shoulder subluxation was analyzed with associated factors.

Results

Of 154 stroke patients, this retrospective study included 109 patients who met the inclusion criteria, 28 patients had shoulder subluxation. After univariated analysis, shoulder subluxation was significantly associated with motor power of shoulder and elbow, loss of proprioception, stroke duration and functional ability. Especially elbow extensor less than poor grade is mostly related to shoulder subluxation among the motor powers. Then multivariated analysis was carried out including all significant subjects, elbow extensor less than poor grade, loss of proprioception and stroke duration more than 6 months were related to shoulder subluxation.

Conclusions

Post stroke shoulder subluxation was commonly observed, and the incidence was 25.6% in this study. Shoulder subluxation was correlated with muscle power of elbow(less than F grade), loss of proprioception and stroke duration more than 6 months

Keywords: Rehabilitation, Stroke, Subluxation

References

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Fig 1.
(A) Schematic description of shoulder subluxation. VD (vertical distance) is the distance from the most inferolateral acromial point (a) to the most upperpoint (b) of the humeral head. (B) And radiologic measurement of VD in shoulder anteropostrior plane film.
kmj-30-59f1.tif
Table 1.
Baseline demographics (n=109).
Baseline variables Number(%) Mean±SD
Sex    
male 67 (61.4%)  
female 42 (38.5%)  
Height(cm)   165.3±8.56
≤160 24 (24.5%)  
161–180 70 (71.4%)  
≥181 4 (4.1%)  
Age(yrs)   55.6±13.19
≤40 14 (12.8%)  
41–60 52 (47.7%)  
≥61 43 (39.4%)  
BMI   22.9±2.95
≤21 21 (21.6%)  
21–23 35 (36.1%)  
23–25 20 (20.6%)  
≥25 21 (21.6%)  
Type of Stroke    
Brain hemorrhage 66 (60.6%)  
Brain infarction 43 (39.4%)  
Weakness side    
Left 43 (39.4%)  
Right 52 (47.7%)  
Bilateral 14 (12.8%)  
Table 2.
Clinical examination at admission (n=109).
Baseline variables Number(%) Mean±SD
Shoulder MMT    
Flexor ≤ 2 63 (57.8%)  
Flexor > 3 46 (42.2%)  
Extensor ≤ 2 61 (56.0%)  
Extensor > 3 48 (44.0%)  
Elbow MMT    
Flexor ≤ 2 52 (47.7%)  
Flexor > 3 57 (52.3%)  
Extensor ≤ 2 54 (49.5%)  
Extensor > 3 55 (50.5%)  
Loss of Proprioception    
No 51 (46.8%)  
Yes 58 (53.2%)  
MAS    
0 59 (54.1%)  
≥ 1 50 (45.9%)  
LOM    
No 36 (33.0%)  
Yes 73 (67.0%)  
Ambulation    
Independent 21 (19.3%)  
Impossible or dependent 88 (80.7%)  
MBI   54.7±20.57
≤75 62 (56.9%)  
≥76 47 (43.1%)  
MMSE   21.7±6.44
≤24 49 (50.0%)  
≥25 49 (50.0%)  
Pre Stroke History    
No 98 (89.9%)  
Yes 11 (10.1%)  
Duration(months)    
< 6 92 (84.4%)  
≥ 6 17 (15.6%)  
CO-morbid disease    
Diabetes mellitus 25 (22.9%)  
Hypertension 56 (51.4%)  
Osteoporosis 5 (4.6%)  
Table 3.
Univariate analysis of factors associated with subluxation (n = 28).
Baseline variables Subluxation (%) P-value
Yes No
Female sex 12 (28.6) 30 (71.4) 0.655
Age 41–60 14 (26.9) 53 (75.7) 0.829
BMI ≥ 25 6 (28.6) 15 (71.4) 0.776
Height < 160 7 (29.2) 17 (70.8) 0.788
MMT      
Shoulder flexor ≤ 2 22 (34.9) 41 (65.1) 0.014∗
Shoulder extensor ≤ 2 20 (32.8) 41 (67.2) 0.077
Elbow flexor ≤ 2 19 (36.5) 33 (63.5) 0.016∗
Elbow extensor ≤ 2 22 (40.7) 32 (59.3) 0.000†
Hemorrhagic type of stroke 19 (29.2) 47 (70.8) 0.377
Pre Stroke History 3 (27.3) 8 (72.8) 1.000
Left hemiplegia 15 (34.9) 28 (65.1) 0.115
Spasticity(MAS) ≥ 1 16 (32.0) 34 (68.0) 0.555
Cognitive ability(MMSE-K) < 24 11 (22.4) 38 (77.6) 0.815
Loss of proprioception 19 (32.8) 39 (67.2) 0.007†
6 months after stroke onset 8 (47.1) 9 (52.9) 0.037∗
Limited range of motion 21 (28.8) 52 (71.2) 0.356
Independent ambulation 6 (28.6) 15 (71.4) 0.783
Diabetes mellitus 5 (20.0) 20 (80.0) 0.604
Hypertension 15 (26.8) 41 (73.2) 0.829
Osteoporosis 2 (40.0) 3 (60.0) 0.601
Functional ability (MBI) ≤ 75 20 (32.3) 42 (67.7) 0.048∗

∗ P-value < 0.05

† P-value < 0.01

Table 4.
Multivariate analysis of risk factors associated with shoulder subluxation
  Odd Ratio 95% CI P-value
MMT of elbow extensor ≤ 2 17.91 1.74–184.41 0.015∗
Loss of proprioception 3.29 1.07–10.13 0.038∗
Duration after stroke onset ≥ 6 months 3.42 1.01–11.58 0.049∗
Functional ability (MBI) ≤ 75 1.68 0.51–5.50 0.390

∗ P-value < 0.05

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