Is it recommended to do physiotherapy (more than electric simulation)…

My mother had a stroke three months ago. Her left part of her body was paralyzed. Now she can walk with a stick but she can not move her arm. When the stroke happened, she fell and her shoulder went out from socket. The doctors, after one month when the stroke occurred, recommended to do a radiography. So they intervened and put the shoulder to the right position. Meanwhile she was advised to not move the arm for one month. After another month, with another radiography the doctors said that a Subluxation (drop) of the arm has occurred. I had two questions. First: Some doctors said that a surgery is a solution. Some said that it is not. The muscles do not hold the arm. Only with physiotherapy it can be improved. So now we are trying with physiotherapy. I thought to ask for an advice. In which cases the surgery is necessary? The second question: The physiotherapist is just using electric simulation for the muscles of the arm. Are exercises (movements) recommended? If yes, what kind of exercises? I am looking forward to your recommendations. Thank you for your time!

Hi Gerta,

Thank you for asking us this question about subluxation, and recommended treatments. I am sorry to hear about your mother’s stroke and some of the ongoing issues she is having with her arm. It sounds as though she has worked really hard to get back on her feet after having her left side paralysed. This is a huge achievement!

In terms of her shoulder, our guidelines state that electrical stimulation may be beneficial to prevent or reduce subluxation post stroke. This relates to subluxation as a result of muscle weakness post stroke. You can find the guideline here. We would recommend the use of electrical stimulation for this reason.

In relation to the inability to move her arm, it sounds like electrical stimulation would need to be used in conjunction with motor training and that she may be too weak to do exercises without this device. Mental practice in conjunction with active motor training may also be used to improve arm function in severe hemiplegia. There has been some promising info on robotics and severe hemiplegia (although these may be more expensive options) Please find these guidelines here

Although I referred to subluxation as a result of stroke, the mechanism of your mother’s injury sounds a bit different. As you described a fall and her shoulder coming out of it’s socket, this type of injury may have caused further damage such as to ligaments, nerves, tears to the socket, tendons, torn muscles etc. As the shoulder was then put back in the right position, I am unsure how much damage has occurred. As other structures may have been injured, the healing of these structures may not be targeted through electrical stimulation. If this is the case, then surgery may be considered.

It would be worth discussing what the surgery involves and seek further clarification about the damage to the shoulder. It is also important for them to look at your mother holistically. Is the surgery going to help her regain function in the long run? Does she have a lot of pain? Electrical stimulation has not shown to decrease the amount of pain in subluxation post stroke.

I hope this helps. If you need us again, please don’t hesitate to call us on StrokeLine 1800 787 653

Warm regards,

Kath (StrokeLine)