Academic Subject Mentor Clinical Pearl

Managing 2-Finger Inferior Shoulder Subluxation in Subacute MCA Stroke (Brunnstrom Stage 2)

Topic Summary & Background: A 62-year-old male 3 weeks post-right MCA ischemic infarct presents with Left flaccid hemiparesis and a noticeable 2-finger sulcus sign at the left glenohumeral joint upon upright standing, with early traction discomfort.

Key Discussion Questions:

Does prolonged Bobath shoulder sling use encourage adductor-internal rotator spastic pattern?
Optimal electrode placement for Functional Electrical Stimulation (FES) to prevent subluxation?
Should weight-bearing through the extended wrist and elbow in sitting be prioritized over overhead pulleys?

Standard Clinical Consensus: Standard Clinical Consensus: Overhead reciprocating pulleys are strictly contraindicated in flaccid hemiplegia due to high risk of subacromial impingement and complex regional pain syndrome (CRPS). FES applied to posterior deltoid and supraspinatus for 30–60 minutes daily significantly reduces sulcus depth.

Managing 2-Finger Inferior Shoulder Subluxation in Subacute MCA Stroke (Brunnstrom Stage 2)

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