Yvonne Khor is a senior physiotherapist and founder of YK Natural Physio & Academy with over 8 years of experience. She provides training on how to prevent and treat shoulder subluxation, a common complication after stroke where the shoulder partially dislocates. The document discusses assessing the grade of subluxation, using positioning, slings, bracing and exercises to strengthen muscles and support the shoulder joint. Prevention techniques like proper positioning and avoiding overstretching can help reduce the risk of subluxation developing after a stroke.

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Yvonne Khor
• Ms. Yvonne is a senior physiotherapist
and the founder of YK Natural Physio &
Academy.
• She has a Master in Rehabilitation
Technology and Bachelor of
Physiotherapy
• Instructor for taping
• Accumulated 8 years of experiences in
physiotherapist field including
musculoskeletal, stroke, sports injuries
and others
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How to Prevent and Treat
Subluxation after Stroke
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What is Shoulder Subluxation ?
● Shoulder subluxation is a common post-stroke complication affecting up
to 80% of the stroke subjects (Arya KN, 2018)
● Shoulder subluxation is defined as a partial or incomplete dislocation
that usually stems from changes in the mechanical integrity of the joint.
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Why Subluxations Need to be Treated?
● To prevent shoulder pain
● To improve the muscle strength
● To avoid disturbances of hand recovery in stroke
● To avoid the disability of hand
● To avoid neck and back pain
● To increase the functional activities of the hand
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Steps to Treat Shoulder Subluxation
Assess the
Shoulder
Subluxation
Positioning
Weight
Bearing
Exercises
Shoulder
Bracing
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How to Assess Shoulder Subluxation?
● Use fingers to measure the grade of the subluxation by placing it
below the bony prominence on the lateral side of your shoulder
without any support on the arm.
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Fingerbreadth Palpation Method
STEP 1 :
Rest the arm at
the side without
any support.
STEP 2 :
Place the fingers
blow the bone
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Grade 0 = no subluxation
Grade 1 = ½ fingerbreadth gap
Grade 2 = 1 fingerbreadth gap
Grade 3 = 1½ fingerbreadth gap
Grade 4 = 2 fingerbreadth gap
Grade 5 =2½ fingerbreadth gap
How to Assess Shoulder Subluxation?
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Grade of Shoulder Subluxation
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How to Treat Shoulder Subluxation?
Hand Positioning
• Correct positioning at an early stage can promote body awareness,
prevent shoulder subluxation and reduce tone spasticity. (Kyeong Woo Lee, et al, 2015)
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How to Treat Shoulder Subluxation?
Slings (Devayani Mukund Moghe et al., 2020)
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How to Treat Shoulder Subluxation?
Different types of brace can be used to support the shoulder joint:
Note: Every patient’s condition may vary, kindly get professional advice to get the suitable brace for
your current condition.
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Shoulder Brace
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How to Treat Shoulder Subluxation?
Weight Bearing Exercise (EH Kim, et al., 2013)
Note: Every patient’s condition may vary, kindly get professional advice to get the suitable exercises
for your current condition. 12

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How to Treat Shoulder Subluxation?
Weight Bearing Exercise in Upper Extremities Help to Increase Muscle
Contraction (Tim L. Uhl et al., 2003)
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Weight Bearing Exercise
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How to Treat Shoulder Subluxation?
• Electro therapy stimulates the muscles surrounding the shoulder joint
• Mobilising the scapular to avoid muscles spasm and pain
• Taping to stabilize the shoulder joint
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Note: Every patient’s condition may vary, kindly get professional advice to get the suitable exercises
for your current condition.
Other Treatments
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How to Treat Shoulder Subluxation?
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Note: Every patient’s condition may vary, kindly get professional advice to get the suitable exercises
for your current condition.
Other Exercises
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How to Treat Shoulder Subluxation?
Effect of Jeonbuk Tri-Pull Taping and Proprioceptive Neuromuscular Facilitation Exercise on
Shoulder Active Range of Motion, Pain, Subluxation, Upper Extremity Function and Activities of Daily
Living in Patients with Stroke (Kim et al., 2019)
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Case Study
● 3 years post-stroke patient
● 3 months of tele-rehab training
Before (1st month) After (3rd month) 17
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How to Prevent Shoulder Subluxation?
● Start prevention right after you get a stroke.
● Prevention is always better than cure.
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How to Prevent Shoulder Subluxation?
• Do not pull on the hand
• Sitting without elbow support and other improper positioning
• Do not over stretch your shoulder
• Get suitable home exercise and guidance on how to do perform these
correctly from a therapist
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Thank You
Q & A Session
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