Type of Article:  Original Research

Volume 8; Issue 2.1 (April 2020)

Page No.: 7418-7423

DOI: https://dx.doi.org/10.16965/ijar.2020.119


Ushnish Mukherjee 1, Swapan Kumar Mishra *2, Prabir Mandal 3, Subhra Mandal 4, Sourav Kundu 5, Pankaj Kumar Mandal 6.

1 Senior Medical Officer GR-III, Department of Physical Medicine & Rehabilitation(PM&R), MR Bangur SSH, Kolkata-33, West Bengal(WB), India.

*2 Associate Professor, Department of PM&R, North Bengal Medical College, WB, India.

Senior Medical Officer GR-I, Department of PM&R, MR Bangur SSH, Kolkata, WB, India.

Professor & HOD, Department of Anatomy, Diamond Harbour Medical College, WB, India.

DTO, Paschim Bardhaman, Department of Health & Family Welfare, Swasthya Bhawan, WB, India.

6 Professor & HOD, Department of PM&R, R G Kar Medical College & Hospital, Kolkata, WB, India.

Corresponding Author: Dr. Swapan Kumar Mishra, Associate Professor,Department of PM&R, North Bengal Medical College, Sushrutanagar, Darjeeling, India. phone-8585046797.

E-Mail: docpmr@yahoo.com


Background:  Stroke is the most common neurological condition causing long term disabilities in various ways. Post-stroke shoulder subluxation, mainly the Gleno-humeral Subluxation (GHS) of the affected side is often detected as a complication. Numerous  theories exist to explain the pathomechanics of developing GHS,but studies regarding its relationship with the sensori-motor recovery of the affected limb is still controversial.

Aim of Study:  To ascertain the correlation between Gleno-humeral subluxation with sensori-motor recovery of the affected upper limb following stroke.

Method:  This correlation study was conducted on 30 patients of both sexes within the age group of 45-65 years with post-stroke (duration < 6weeks) Gleno-humeral subluxation( GHS). Screening of GHS was done by palpation and degree of GHS was quantified by High resolution USG by measuring the Acromion – Greater Tuberosity Distance difference (AGTDD)  between two shoulders. Sensorimotor recovey of the affected limb was assessed by Fugl – Meyer Assessment Scale of Upper Extremity (FMA-UE). Data collected at the baseline (visit1), at 6 weeks (visit 2), 12 weeks (visit 3) and at the end of the study i.e 24 weeks (visit 4).

Results:   Pearson Correlation (r) in all visits (V1: r=-0.926, p=0.000. V2: r=- 0.947, p=0.000. V3: r=- 0.912, p=0.000. V4: r=- 0.924, p=0.000) established a statistically significant negative correlation between degree of shoulder subluxation and sensory-motor recovery.

Conclusion:  Post-stroke GHS is a significant  complication which undoubtedly   plays a cardinal negative role during sensori-motor recovery of the affected upper limb.

Key words: Gleno-humeral subluxation (GHS), Acromion-Greater Tuberosity Distance difference (AGTDD), Fugl-Meyer Assessment Scale of Upper Extremity (FMA-UE).


  1. Stein J, Brandstater ME. Stroke Rehabilitation. In: Frontera WR, Delisa JA(eds), DeLisa’s Physical Medicine & Rehabilitation Principle And Practice, 5th ed, Philadelphia PA,USA: Lipincott Williams & Wilkins ,a Wolters Kluwer business, 2010;chapter23,p551-571.
  2. Paci M., Nannetti L, Rinaldi L A; Glenohumeral subluxation in hemiplegia: An overview. Journal of rehabilitation research and development, 2005;42(4):557-68.
  3. Türkkan C, Öztürk GT, Uğurlu FG, Ersöz M. Ultrasonographic assessment of neuromuscular electrical stimulation efficacy on glenohumeral subluxation in patients with hemiplegia: a randomized-controlled study. Turkish Journal of Physical Medicine and Rehabilitation. 2017 Dec;63(4):287.
  4. Chaco, J., & Wolf, E. Subluxation of the glenohumeral joint in hemiplegia. American journal of physical medicine & rehabilitation, 1971;50(3):139-143.
  5. Basmajian, J. V., & Bazant, F. J. Factors Preventing Downward Dislocation of the Adducted Shoulder Joint An Electromyographic and Morphological Study. The Journal of Bone & Joint Surgery,1959; 41(7):1182-1186.
  6. Wanklyn P, Forster A, Young J. Hemiplegic shoulder pain (HSP): natural history and investigation of associated features. Disabil Rehabil.1996;18:497–501.
  7. Cailliet R. Shoulder Pain, 3rd ed. Philadelphia:F.A. Davis,1991;2.
  8. Park GY, Kim JM, Sohn S, Shin IH, Lee MY. Ultrasonographic Measur ement of Shoulder Subluxation in Patients with Post-stroke Hemi plegia. J Rehabil Med 2007;39:526–530.
  9. Fugl-Meyer Assessment Upper Extremity (FMA-UE), Assessment of sensorimotor function, Rehabilitation Medicine, University of Gothenburg. Approved by Fugl-Meyer AR 2010.
  10. Kumar, P., Cruziah, R., Bradley, M., Gray, S. and Swinkels, A. Inter-rater and intra-rater reliability of ultrasonographic measurements of acromion-greater tuberosity distance in post- stroke hemiplegia. In:Joint Summer Meeting of the British Society of Rehabilitation Medicine & The Society for Research in Rehabilitation, Keele, UK, 4th – 5th July,2011.
  11. Williams, R., Taffs, L., & Minuk, T. Evaluation of two support methods for the subluxated shoulder of hemiplegic patients. Physical Therapy, 1988;68(8):1209-1214.
  12. Brandstater ME. Basic aspects of impairment evaluation in stroke patients. In: Chino N, Melvin JL, eds. Functional Evaluation of Stroke Patients. New York: Springer-Verlag; 1996:9–18.
  13. Paci M, Nannetti L, Taiti P, Baccini M, Pasquini J, Rinaldi L. Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiotherapy Research International. 2007 Jun1;12(2):95-104.
  14. Zorowitz RD, Idank D, Ikai T, Hughes MB, Johnston MV. Shoulder subluxation after stroke: a comparison of four supports. Arch Phys Med Rehabil1995;76:763-71.
  15. Zorowitz RD. Recovery patterns of shoulder subluxation nafter stroke: a six-month follow-up study. Top Stroke Rehabil.2001;8:1–9.
  16. Kumar P, Bradley M, Gray S, Swinkels A. Association between ultrasound assessment of glenohumeral subluxation and shoulder pain, muscle strength, active range of movement and upper limb function in people with stroke. European Journal of Physiotherapy. 2019 Jan;23:1-7.
  17. Jung KM, Choi JD. The Effects of Active Shoulder Exercise with a Sling Suspension System on Shoulder Subluxation, Proprioception, and Upper Extremity Function in Patients with Acute Stroke. Medical science monitor: international medical journal of experimental and clinical research. 2019;25:4849.
  18. Nadler M, Pauls MM. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clinical rehabilitation. 2017 Apr;31(4):444-53.
  19. Arya KN, Pandian S, Vikas, Puri V. Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review. Topics in stroke rehabilitation. 2018 Jan 2;25(1):68-81.

Cite this article: Ushnish Mukherjee, Swapan Kumar Mishra, Prabir Mandal, Subhra Mandal, Sourav Kundu, Pankaj Kumar Mandal. SENSORI-MOTOR RECOVERY IN POST-STROKE SHOULDER SUBLUXATION: A NON INVASIVE CORRELATION STUDY. Int J Anat Res 2020;8(2.1):7418-7423. DOI: 10.16965/ijar.2020.119