VALIDITY OF CLINICAL MEASURES OF SHOULDER SUBLUXATION IN ADULTS WITH POSTSTROKE HEMIPLEGIA

Objectives. Shoulder subluxation after cerebrovascular accident has be en associated with chronic Pain, orthopedic complications, Peripheral nerve damage, and autonomic dysfunction. Clinical diagnosis and gradua tion of subluxation is problematic due to the lack of precision in fre quently used measures. The objective of this study was to assess the v alidity of clinical techniques used to assess inferior subluxation of the hemiplegic shoulder by comparing these techniques with radiographi c measurement. Method. In 20 male subjects with hemiplegia, the presen ce, type, and degree of subluxation was assessed with three clinical m easures: palpation, arm length discrepancy, and thermoplastic jig meas urement. Anterior-posterior X rays of the hemiplegic shoulder were tak en after clinical examination. Results. Spearman rank correlation coef ficients between the X rays and the three clinical measures were relat ively low. Palpation had the highest correlation (r(s) = .76), followe d by arm length discrepancy (r(s) = .46), and thermoplastic jig measur ement (r(s) = .42). Conclusion. these findings provide cautious optimi sm about using these clinical measures to identify subluxation. Althou gh detection was best with palpation, the likely inability to determin e clinical overcorrecting of subluxation makes use of palpation alone suspect. Improved techniques of arm length measurement may provide a s olution to this problem. These findings further necessitate that impro ved procedures for clinical assessment of subluxation be developed.