1 4 . H O W T O U S E T H E W I R E L E S S P R O F E S S I O N A L O N S P E C I F I C
I N D I C AT I O N S
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WIRELESS PROFESSIONAL
14.11.4 the hemiplegic shoulder
reminder
One of the specific problems commonly encountered in hemiplegic patients is subluxation of the paretic or
paralysed shoulder.
Atrophy with loss of strength which affects the abductor muscles of the arms (deltoid and supraspinatus
muscles) results in an inability to provide satisfactory support for the head of the humerus. In addition,
more or less pronounced spasticity of the depressor muscles of the shoulder (pectoralis major and
latissimus dorsi) causes a downward pull on the head of the humerus, which adds to the pull caused by
the weight of the limb.
This situation commonly leads to the displacement of the head of the humerus from the glenoid cavity.
Radiologically, it is clear that the axis of the anatomical neck of the humerus no longer passes through the
centre of the glenoid cavity.
This is inferior subluxation.
This subluxated shoulder can often cause pain. The pain can remain localised around the shoulder, but can
also radiate into the upper limb towards the hand through stretching of branches of the brachial plexus.
Vasomotor and trophic disorders of the hand, such as those seen in algoneurodystrophy (complex regional
pain syndrome) may be combined, resulting in classic shoulder-hand syndrome.
use of neuromuscular electrical stimulation (NMeS)
NMES of the abductor muscles of the arm (deltoid and supraspinatus) may be used to prevent or treat
atrophy and reduce spasticity in the latissimus dorsi and pectoralis major muscles.
This technique is indicated in the prevent or treatment of subluxation of the shoulder in hemiplegic
patients. Radiological investigations show evidence of re-centring of the humeral head in relation to the
glenoid cavity.
Moreover, pain in the shoulder and upper limb often associated with subluxation is effectively reduced by
this type of treatment. However, in the event of pain radiating in the upper limb, the analgesic action can
be supported by using TENS (Gate control), which is programmed on the third and fourth channel.
In shoulder-hand syndrome, in addition to shoulder pain, which is itself a secondary problem associated
with hemiplegia, complex regional pain syndrome (CRPS) can occur, which affects the hand. In this
situation, CRPS should be treated using the programmes and method described in this chapter, which deal
with this disorder (algoneurodystrophy).
14.11.4.1 Protocol
The hemiplegic shoulder