The shoulder joint is the most mobile joint in the body consisting of bones, muscle, ligaments, and tendons. It consists of three main bones: the humerus, scapular and clavicle, which work together, with the muscles and ligaments, to keep the shoulder stable and mobile. However, due to the high level of mobility at the shoulder joint it is highly susceptible to injury and subluxation.
Shoulder subluxation refers to a partial dislocation of the shoulder joint where humeral head slips of out the shoulder socket joint as a result of weakness or injury. Shoulder subluxation can occur due to many reasons, including stroke, hemiplegia, peripheral nerve injury, brachial plexus injury and many more. Symptoms can manifest as pain, swelling, reduced range of motion, paralysis of the arm, and numbness and/or tingling (also known as paraesthesia) of the arm.
Bracing for shoulder subluxation therefore aims to re-position the humerus back into the socket at ensure it stays in place. Most shoulder braces are intended to protect the shoulder joint from subluxation caused by flaccid hemiplegia or injury in the shoulder joint capsule. Hemiplegic shoulder pain can considerable distress, reduced activity, and hinder rehabilitation. Shoulder braces can come in all shapes and designs to support the shoulder as needed.
The simplest form of shoulder bracing is a sling which supports the weight of the forearm and hand, reducing the strain on the shoulder. A sling can protect from further subluxation, reduce pain and protect the arm from injury from swinging. Slings are easy to fit and a simple device to wear. However, complete immobilisation of the arm results in reduced functionality and holds the arm in a less desirable long-term position of internal rotation and elbow flexion. These devices also need to be worn visibly over clothing.
Shoulder braces are also available which support directly around the shoulder joint. These braces anchor across the body to reduce the strain on the shoulder. These braces can be worn more cosmetically under the clothing and provide compression for increased pain reduction and proprioceptive feedback. However, they do not support the forearm which can make the arm feel heavy and uncomfortable.
Finally, shoulder braces with additional forearm extensions are available for increased support. These braces consist of two parts connect via straps and can be a little more difficult to fit. They cover a larger area for increased positive impact of support and proprioception and pain relief. These devices can also be worn directly under clothing for increased cosmesis and this design hold the shoulder in a more desirable position of arm by rotating the shoulder outwards slightly which can counteract the typical spastic posture patterns associated with hemiplegia.
It is important to select a shoulder brace based on your individual need, injury, movement ability, pain levels and support required. If you have any questions about our range shoulder support or would like to speak with one of our Orthotists please contact us at https://totalbodyorthotics.com/contact/