The purpose of this study is to compare the effectiveness of the Rolyan, hemisling, remodified Bobath, and the newly designed triangular Bobath slings. Sixteen patients with a shoulder subluxation were evaluated by the simple shoulder AP X-rays with and without slings. The hemisling was applied with the elbow flexed at 90 and 120 degrees. The radiologic evaluation for the detection of shoulder subluxation was done by measuring the vertical and horizontal displacement on a plain AP view. The mean value of vertical displacement without a sling application was 5.21 cm which was reduced to 4.30 cm by a triangular Bobath sling application and 4.32 cm by a hemisling application at 120°elbow flexion. These two slings significantly corrected the vertical displacement, but other were not. In nine of sixteen patients, the triangular Bobath sling was the best sling for the vertical correction. All slings except a hemisling increased the horizontal displacement even though it was not statistically significant. The triangular Bobath sling improved the discomfort of the axilla better than the remodified Bobath sling.

The results support that the triangular Bobath sling was the best among 4 slings for the correction of shoulder subluxation, although a reduction in lateral displacement and an improvement in applicability need to be explored further.

Objective: The aim of this study is to know the usefulness of ultrasonographic evaluation of hemiplegic shoulder pain.

Method: For 20 hemiplegic patients with shoulder pain, the shoulder was evaluated by simple radiographic findings, physical examinations, visual analogue scale (VAS), manual muscle test (MMT), and finally the ultrasonographic examination to define shoulder pain nature. The ultrasonographic results were compared to the simple radiography, physical examination, VAS, and MMT.

Results: The ultrasonographic findings were variable. The positive ultrasonographic findings were 10 joint fluid collections, 3 tendinous thickenings, 4 high echogenic findings, 4 tendon surface defects, 2 tendinous gracilings, and 1 joint surface irregularity. The ultrasonographic interpretative conclusion included 6 tendon (or muscle) tears, 2 degenerative changes, 5 nonspecific simple joint fluid collections, and 7 normal shoulder joints. In comparison of ultrasonographic findings and subluxation, VAS, and fluid collection, VAS showed relatively higher correlation.

Conclusion: The ultrasonography is very useful as a non-invasive, inexpensive, painless, and rapid screening diagnostic method for the evaluation of painful hemiplegic shoulder.

Objective: Hip deformity is one of the common problems in children with cerebral palsy. And it is important to detect hip subluxation or dislocation as early as possible. The purpose of this study is to find the incidence of hip subluxation in early childhood in patients with cerebral palsy.

Method: We reviewed clinical and radiological records of children with cerebral palsy under 36 months of age. We measured migration index, acetabular index, center edge angle and neck shaft angle from hip X-ray of patients.

Results: Total 76 patients were included in this study. The mean of migration index was 4.5⁑7.5% at 8∼12 months, 10.9⁑11.9% at 13∼24 months, and 18.2⁑13.0% at 25∼36 months (p＜0.05). Twenty one patients (27.6%) were above 25% on the migration index. The neuromotor type of cerebral palsy in 21 patients with hip subluxation, were spastic in 20 (95.2%) except one child. The incidence of hip subluxation was 25.0% (8/32) for quadriplegia, 29.6% (8/27) for diplegia and 50.0% (4/8) for hemiplegia. The acetabular index was significantly higher and the center edge angle was lower in the subluxated hip group than in the non-subluxated hip group, though no significant difference in the neck shaft angle.

Conclusion: We concluded that the hip subluxation in cerebral palsy can occur under 36 months of age with a relatively high incidence. Therefore, it is recommended to evaluate the hip of cerebral palsy with radiological as well as clinical examination in early childhood. (J Korean Acad Rehab Med 2002; 26: 514-518)

Objective: 1. To determine the difference of scapulohumeral rhythm (SHR) between the affected and unaffected side in hemiplegic patients. 2. To discover the influencing factors on altered scapulohumeral rhythm of affected side in hemiplegic patients.

Method: Fifteen hemiplegic subjects, 18 to 54 years of age, participated in this study.

Subjects were divided into two groups according to muscle tone on the basis of modified Ashworth scale (MAS). Plain X-ray of the shoulders were taken in neutral, 90 degree abduction, and full elevation of the arm in both affected and unaffected side. The arm angle, scapula angle, and glenohumeral angle were recorded for each individual in each of the three positions.

Result: In the unaffected shoulders of hemiplegic patients, the mean values of SHRs from neutral to the 90^o and from neutral to the 180^o were 1：1.82 and 1：2.12, respectively. In the affected shoulders, the mean values of SHRs between 0∼90^o abduction and 0 to full abduction were 1：2.35 and 1：2.25, respectively. The mean value of SHRs from neutral to 90 degree of affected side was significantly decreased than unaffected side in the low tone group and increased in the high tone group (p＜0.05). In addition, the SHRs of hemiplegic shoulders were significantly increased in the high tone group than the low tone group (p＜0.05).

Conclusion: Spasticity tends to result in decreased motion of scapula, which alters the SHR. A glenohumeral-to-scapulothoracic ratio of hemiplegic shoulder could be affected by spasticity and presence of subluxation.

Method: 20 hemiplegic patients (right: 10, left: 10) were evaluated LSST in resting position at three different points (T2-Superior Angle, T3-Scapular Spine, T7-Inferior Angle) in three times of the both shoulder. Muscle power of shoulder, Brunnstrom stages, spasticity, subluxation degrees using X-ray studies and ROM pain degrees using Visual Analog Scale (VAS) were also evaluated to examine the clinical correlation.

Results: This study showed the evidence of positive correlation with LSST and shoulder subluxation, ROM pain degrees using VAS at T7-inferior angle (p＜0.05), and negative correlations with LSST with shoulder abduction muscle power and Brunnstrom stage. But, there were no correlations with shoulder spasticity and hemiplegic side.

Conclusion: This study provided LSST can be a useful predictor of shoulder subluxation and it supposed that the glenoid fossa on the affected side was upward rotated compared to the unaffected side. (J Korean Acad Rehab Med 2003; 27: 819-823)

Method: Sixteen hemiplegic patients with shoulder subluxation were evaluated by a simple X-ray with and without the slings and the vertical and horizontal distances on the plain AP views were measured. The newly designed arm sling was compared in terms of the effects of correction with a pouch sling and a Bobath sling. The arm sling designed for this study was developed for the purpose of maintaining patients' hands in a functional position and performing ROM exercise of the shoulder easily. The mean values of the vertical and horizontal distance were compared to determine if there was significant difference of function between the new sling and the conventional slings. Variables such as comfort, choice, and easiness for donning and doffing of the arm slings were evaluated by questions.

Resuts: The new sling provided the patients with good vertical correction of the subluxation (p＜0.05) but did not increase the horizontal distance significantly. According to the responses to the questions, the new sling was more comfortable than the conventional slings.

Conclusion: These results support the effectiveness and the comfort of a new sling to decrease subluxation in hemiplegia. Further study on the long term effects or complication of the new sling is recommended.

Objective: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients.

Method: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment.

Results: 1) The severity of subluxation was significantly increased after 6 weeks (p＜0.05) in the control group. In the study group, it was reduced but the difference was not statistically significant (p＞0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period.

Conclusion: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.

A 29 years old woman had suffered from posterior neck and right shoulder pain for one year. She was given a spinal manipulation that was by a non-licentiate at a non-hospital. Posterior neck and shoulder pains were worsened and headache was developed after the spinal manipulation. She was recommended to be kept on the manipulation. Although physical finding was non-specific, radiologic findings of CT and MRI revealed atlantoaxial subluxation. After cervical immobilization and anti-inflammatory drug medication for three months, she recovered and did return to her work. We expect that atlantoaxial subluxation after spinal manipulation is not rare even in healthy young person without underlying pathology and can progress to serious complications unless detailed examination and management are undertaken.

Method: Sixty shoulders in hemiplegic patients with shoulder pain were evaluated by physical examination, visual analogue scale, plain X-ray, arthrogram, ultrasonography and 3-phasic bone scan.

Results: The subluxation of shoulder on X-ray was found in 45 patients. The abnormal findings of arthrogram were 39 patients and the most common finding was adhesive capsulitis. The abnormal findings of ultrasonography were 45 patients and the most common finding was supraspinatus tendinitis. In cases of shoulder subluxation on X-ray, many cases were associated with supraspinatus tendinitis on ultrasonography and with adhesive capsulitis on arthrogram. In comparison with the arthrogram and ultrasonography, partial and complete rotator cuff tear findings show consistency. And patients with adhesive capsulitis on arthrogram show significantly high incidence of biceps tendinitis finding on ultrasonography.

Conclusion: In hemiplegic patients with shoulder pain, the ultrasonography is more valuable and useful as an invasive diagnositc method for the evaluation of rotator cuff tendinitis especially when there is subluxation in X-ray and adhesive capsulitis in physical examination. (J Korean Acad Rehab Med 2003; 27: 293-299)

Method: Sixty-four stroke patients (40 male; 24 female, mean age: 59.2⁑10.4) were included in the study. All subjects underwent a clinical examination that included spasticity and Brunnstrom stage; and a radiologic examination. The diagnosis of CRPS was based on clinical criteria and three-phase scintigraphies. The degree of shoulder subluxation was assessed by the distance between inferomedial point of acromion and the center of humeral head and glenoid fossa.

Results: CRPS after stroke occurred in 34 patients (53%). There were significant differences in Brunnstrom stage and shoulder subluxation between the CRPS groups and the non CRPS groups. Among radiographic measurements, vertical distance ratio (involved/uninvolved) and oblique distance ratio indicated a strong correlation with CRPS (p＜0.01). Among clinical variables and radiographic measurements, oblique ratio was the most valuable determinant of the risk for CRPS.

Conclusion: Shoulder subluxation shows a significant correlation with CRPS after stroke. We suggest oblique ratio as a useful measurement of shoulder subluxation to estimate the risk of CRPS. (J Korean Acad Rehab Med 2003; 27: 21-26)