Tracking changes in glenohumeral joint position in acute post-stroke hemiparetic patients: an observational study

Abstract

Aims: The majority of people develop hemiparetic shoulder inferior subluxation following stroke, but the timing of onset is unknown. This study aimed to assess changes in glenohumeral joint centre of rotation (GHJC) during the first six weeks following stroke.

Methods: Thirty patients with confirmed diagnosis of stroke (age 65 ± 19 years, 60% female, 40% right side affected) were assessed within 14 days of admission and at six weeks along with matched controls. Bilateral GHJC was determined using a three-dimensional electromagnetic tracking device (ETD).

Results: At baseline, GHJC in the stroke group was positioned posteriorly on the hemiparetic side compared to the non-hemiparetic side (mean difference −4.0, 95% confidence interval (CI) − 7.7 to −3.0 mm). In matched controls, GHJC was positioned anterior to the acromion with no significant difference between limbs. At six weeks, the only significant difference occurred for the stroke group; non-hemiparetic GHJC was positioned 12.3 mm (95% CI 2.5–22.1) closer to the acromion compared with control group.

Conclusion: Minimal changes in glenohumeral joint positioning occurs early post-stroke. Clinicians should consider changes in glenohumeral joint position for both non- and hemiparetic sides during the early rehabilitation phase following stroke.

Implications for rehabilitation

• Changes occur in glenohumeral joint centre of rotation (GHJC) position between hemiparetic and non-hemiparetic sides early in people with mild stroke.

• Clinicians need to be aware of early GHJC positional changes.

• Early GHJC positional changes may contribute to the development of hemiparetic shoulder pain (HSP), anterior humeral subluxation and glenohumeral joint impingement.

• Clinicians should employ current best practice guidelines which promote safe positioning and handling of the upper limb to minimise subluxation forces and potential trauma to the passive restraints of the shoulder in the acute phase following stroke, to reduce the possibility of glenohumeral subluxation in the short term.

Keywords:

• Stroke
• glenohumeral
• hemiparetic
• shoulder

Acknowledgements

Peter Mills for his expertise in the use of the Polhemus, data acquisition and data processing.

Disclosure statement

The authors report no declarations of interest.