<p>PROTOCOL FOR STROKE AND PAINFUL SHOULDER </p><p>1.BASIC ANATOMY</p><p>The shoulder joint has an enomous range of movements. 2/3 of humeral head is not covered glenoid fossa. In normal fuunction the downward subluxation of head of humerus is prevented by the upward of the glenoid fossa. In adduction, the capsule, coraco-humeral ligaments are taut and passively prevent the movement of the humeral head supported by supraspinatus. When humerus is abducted/flexed forwards, the rotator cuff muscles, almost exclusively, ensure stability.</p><p>SIGNS OF SUBLUXATION IN HEMIPLEGIA. a) Droping shoulder due to loss of tone in the elevator of the scapular. b) Scapular close to vertebral column wiith infirioor angle adducteed and lower than on other side. c) Vertebral boarder of scapular wings wiith resistance to correction</p><p>TO CORRECT SHOULDER SUBLUXATION</p><p>Inhibit hypertonicity: Restore mobility to scapula i. rolling over the hemiplegic side ii. Weight bearing through the arm and transferring</p><p>WEIGHT SIDEWAYS</p><p> i. Maintain fill pain-free shoulder elevation ii. Patient to auto assist bi-lateral arm movements forward and up . iii.Stimulate activity and co-contraction of the shoulder musculature iv.Position or place arm forward on a table in sitting.</p><p>PAINFUL SHOULDER A painful shoulder is common and interferes with recovery and rehabilitation .</p><p>OCCURANCE: it may occur fairly early following stroke or after several months.The upper limb may be flaccid or be very spastic .There may be sublaxation or there may no sublaxation unless treated ,the pain will become steadly worse from a localised sharp pain at the end of range of elevation or abduction ,to a widespread,generalized pain when the arm is lifted or lowered.</p><p>TO PREVENT A PAINFUL SHOULDER i.The scapular must be moved and the arm brought into external rotation when the arm is handled . ii.Do not pull on the arm when helping the patient to move from bed to chair or when assisting walking. iii.Do not lift the arm from the hand . iv.Do not use reciprocal pulleys TREATMENT PROTOCOL I . Mobilise the scapula using trunk rotation. ii. Gain full range and pain free elevation. iii. Ensure the patient is doing the self assisted arm with scapular protraction. iv. Check position in bed and sitting. v. Check assisted activities and tranfers.</p>