By CareMotion · Neurological Rehabilitation
The Danger of Flaccid Shoulder Subluxation in Hemiplegia
Following a stroke with hemiplegia (paralysis of one side), the flaccid stage causes complete loss of muscle tone in the rotator cuff and deltoid. Gravity pulls the heavy paralyzed arm downward, causing the humeral head to slip out of the shallow glenoid socket—a painful condition called inferior shoulder subluxation.
Family members and caregivers must NEVER pull or lift a hemiplegic patient by their affected arm during transfers. Traction on a flaccid shoulder causes permanent brachial plexus nerve stretch and excruciating chronic shoulder pain.
- Always support the affected arm on a lap tray, pillow, or specialized hemiplegic shoulder sling when upright.
- Transfer by cupping the patient under their scapula and pelvic girdle, never pulling the arm.
- Perform gentle passive shoulder range of motion while maintaining the humeral head seated in the socket.
Essential Round-the-Clock Bed Positioning Rules
Proper bed positioning inhibits abnormal spastic synergy patterns (such as arm flexion and leg extension) and prevents contractures. Position should be changed every 2 hours to avoid pressure ulcers on bony prominences.
When lying on the affected side, ensure the shoulder blade is pulled gently forward (protracted) so the patient does not lie directly on an impinged shoulder joint.
- Lying on back: Pillow under the affected shoulder and arm elevated slightly above the heart on a cushion.
- Lying on unaffected side: Affected arm supported forward on a pillow, affected leg resting on a pillow in front.
- Lying on affected side: Shoulder well protracted forward, elbow straight, palm upward.
Safe Caregiver Transfer Protocol in Kolkata Households
Transferring between bed, wheelchair, and bedside commode requires a structured protocol. Caregivers should guide movement toward the patient's sound side initially for safety, while encouraging weight-bearing through the hemiplegic foot.
CareMotion physiotherapists assess your bedroom layout, train household members in safe handling, and implement Bobath and NDT neuro-facilitation techniques at home.
- Place wheelchair at a 45-degree angle to the bed with wheel brakes securely locked.
- Instruct patient to lean forward ('nose over toes') to shift center of gravity before standing.
- Ensure patient wears non-slip footwear to prevent foot slipping on marble floors.
General information to help you plan a visit. Individual assessment and your treating team's advice guide rehabilitation decisions.