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Research Article  |   June 1995
Validity of Clinical Measures of Shoulder Subluxation in Adults With Poststroke Hemiplegia
Author Affiliations
  • Jacqueline Hall, MS, OTR/L, is Clinical Specialist, Rehabilitation Medicine, Seattle VA Medical Center, 1660 South Columbian Way, Seattle, Washington 98108
  • Brian Dudgeon, MS, OTR/L, is Lecturer, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
  • Mark Guthrie, PhD, PT, is Assistant Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
Article Information
Neurologic Conditions / Stroke / Special Issue on Stroke
Research Article   |   June 1995
Validity of Clinical Measures of Shoulder Subluxation in Adults With Poststroke Hemiplegia
American Journal of Occupational Therapy, June 1995, Vol. 49, 526-533. doi:10.5014/ajot.49.6.526
American Journal of Occupational Therapy, June 1995, Vol. 49, 526-533. doi:10.5014/ajot.49.6.526
Abstract

Objectives. Shoulder subluxation after cerebrovascular accident has been associated with chronic pain, orthopedic complications, peripheral nerve damage, and autonomic dysfunction. Clinical diagnosis and gradation of subluxation is problematic due to the lack of precision in frequently used measures. The objective of this study was to assess the validity of clinical techniques used to assess inferior subluxation of the hemiplegic shoulder by comparing these techniques with radiographic measurement.

Method. In 20 male subjects with hemiplegia, the presence, type, and degree of subluxation was assessed with three clinical measures: palpation, arm length discrepancy, and thermoplastic jig measurement. Anterior-posterior X rays of the hemiplegic shoulder were taken after clinical examination.

Results. Spearman rank correlation coefficients between the X rays and the three clinical measures were relatively low. Palpation had the highest correlation ( rs= .76), followed by arm length discrepancy ( rs = .46), and thermoplastic jig measurement ( rs = .42).

Conclusion. These findings provide cautious optimism about using these clinical measures to identify subluxation. Although detection was best with palpation, the likely inability to determine clinical overcorrecting of subluxation makes use of palpation alone suspect. Improved techniques of arm length measurement may provide a solution to this problem. These findings further necessitate that improved procedures for clinical assessment of subluxation be developed.